The 12 months That Israel Collapsed Gaza’s Health Care System

Rajaa Musleh quietly sat on the fifth ground of downtown Chicago’s Marriott resort, the place the medical help group she works for, MedGlobal, was holding a convention full of panelists and attendees. Recalling her escape from Gaza lower than a yr in the past, the Palestinian nurse started to battle again tears and the urge to dissociate.

After the Israeli army bombed her home in Gaza Metropolis, Musleh sheltered at Al-Shifa Hospital, the territory’s largest medical complicated. However regardless of medical amenities being so-called deconflicted zones, Israeli forces trapped Musleh and 1000’s of others within the hospital for greater than 40 days whereas killing sufferers and well being care staff alike.

The hospital was nothing wanting chaos. As a humanitarian employee, Musleh helped distribute remedy and tools to hospital employees. Then she would use her medical coaching to assist sufferers within the working room. The overcrowding meant sufferers had been being handled with out painkillers on the emergency room’s blood-covered ground. Musleh noticed little kids with out heads, boys crying for her to take care of their phantom limbs and a severely burned 9-year-old woman who died whereas holding her hand. All of the whereas, Israeli troopers had been abducting well being care staff, Musleh recalled to HuffPost.

“I still smell the burned skin. Sometimes I use heavy perfume, to be honest with you, I use that just to cover the smell of the burn,” Musleh mentioned. “I’m feeling the skin on my hand of this child, and I wash my hands maybe 30 times to remove [the feeling of her] skin. This is what I feel.”

Musleh’s expertise is just not unusual in Gaza, which was besieged on Oct. 7, 2023, after Hamas militants launched an assault on southern Israel that killed about 1,200 individuals whereas about 240 extra had been taken hostage. One yr later, Israel’s ongoing army offensive ― which has now unfold to the occupied West Financial institution, Lebanon, Syria and Yemen ― has killed about 42,000 individuals within the territory, based on the Gaza Ministry of Health. Medical staff estimate the quantity is probably going nearer to 119,000, and plenty of within the worldwide neighborhood now describe the invasion as genocide.

Israeli strikes that use U.S. weapons are largely accountable for the rising dying toll. However the Israeli army has additionally ensured Palestinians’ eradication by a extra sinister technique that may proceed to kill them for years to come back: by collapsing Gaza’s total well being care system.

For this story, HuffPost spoke with seven medical help staff who’ve served in Gaza since Oct. 7, 2023, and heard testimony from practically a dozen extra consultants. The employees embody skilled nurses, nutritionists, surgeons and psychological well being professionals. HuffPost additionally first obtained a letter to the White Home final week that had been signed by practically 100 American well being care staff who demanded an instantaneous arms embargo to Israel and a gathering to debate the horrors they’ve seen within the Palestinian territory.

These medical professionals described how the well being system collapse impacts practically each side of Gaza’s humanitarian disaster, together with the overcrowded hospitals, the blocked help, the focusing on of medical staff, the mass hunger, the absence of maternal care, the unfold of illness, the psychological toll and the short- and long-term results on kids.

Lots of the well being care staff who offered medical help in Gaza are not any strangers to working in battle zones, whether or not it’s a rustic affected by pure catastrophe or torn up by battle and uprisings. These experiences, regardless of how extreme, had been nothing in comparison with Gaza, they mentioned.

Many medical staff who spoke with HuffPost mentioned they knew at the least one colleague who had been kidnapped by Israeli troopers — and that those that returned to Gaza alive had skilled violence by the hands of the troopers.

“It was like a post-apocalyptic movie,” mentioned Dr. John Kahler, MedGlobal’s co-founder and a retired pediatrician who’s offered medical help in battle zones for many years. Kahler has visited Gaza twice since Israel launched its present offensive ― as soon as in January and once more in March, each in Rafah. The physician tried to enter the territory in Could to arrange a vitamin stabilization program in northern Gaza’s Kamal Adwan Hospital however was turned away by Israeli forces.

Gaza’s inhabitants of two.3 million ― about half of whom are kids and practically all of whom have been displaced ― has solely 17 out of 36 out there hospitals open, none of that are totally functioning. Israeli forces have spent the previous yr bombing and laying siege to the hospitals, justifying their actions by claiming Hamas militants are hiding among the many Palestinian civilians, sufferers and well being care staff.

“You felt them constantly,” Dr. Feroze Sidhwa, a surgeon who labored at European Hospital in Khan Younis, mentioned of the bombs. “They broke some windows on the third floor of the hospital. They knocked me out of bed one day. They would knock surgical instruments off the OR table sometimes.”

After the raids, the Palestinian Civil Protection would discover a whole lot of our bodies from at the least seven mass graves at most of the hospitals, together with Al-Shifa, the place Musleh was trapped in November. Lots of the our bodies ― together with girls, kids and the aged ― confirmed indicators indicating they had been sufferers or well being care staff who had been killed execution-style, Palestinian officers mentioned on the time.

“There were signs of the Israeli raid everywhere. You can see the mass grave from the balcony, around 200 people,” Dr. Tammy Abughnaim mentioned of Al-Aqsa Hospital, the place she volunteered in March earlier than coming again to Gaza in the summertime to assist at Nasser Hospital. The emergency doctor recalled how Palestinian well being care staff had been working “on sheer willpower,” with some telling her they had been simply ready to die.

Your entire hospital campus was a camp for displaced individuals, together with for most of the Palestinian well being staff themselves, Sidhwa mentioned. Medical staff, working room employees and nurses lived within the hospital.

When Israeli troopers raided the hospitals, they might typically accuse Palestinian medical staff, with out proof, of working for Hamas. The medical staff HuffPost spoke to mentioned troopers would strive to remove the dignity of their detained colleagues by stripping them of their garments, beating them and dumping them bare on the aspect of a highway.

A Human Rights Watch report from August described the humiliation, violence, torture and sexual abuse that medical staff confronted in custody ― an accusation Israeli officers have denied. Because the offensive started, Israeli forces have taken at the least 310 Palestinian well being care staff, at the least three of whom had died in custody. Practically a thousand medical staff ― about 1 in 20 ― have been killed in Gaza, based on the United Nations.

Israel has additionally arbitrarily blocked most help from coming into Gaza, stopping hospitals from acquiring mandatory tools and drugs similar to anesthesia, in addition to sufficient gas to run the amenities that always go with out electrical energy. Kahler described the scenario as “the paradox of aid availability but not accessibility.”

“When we were coming in from Cairo, we passed no less than 500 trucks waiting on the road to the Rafah gate, and that was in March,” he mentioned of one of many greatest humanitarian routes, which closed in Could. “So now it’s even worse. I could throw a rock from one side of the wall to the other and hit the aid; it just could not get in.”

The Israeli army has publicly claimed, significantly to its allies within the U.S., that it’s permitting extra help into Gaza, however help staff say in any other case.

Medical staff had been permitted within the spring to carry 42 baggage of related help and provides into Gaza, based on Abughnaim. In July, they had been restricted to only one, making it unimaginable to carry with them gadgets like tourniquets, cleaning soap and disinfectant. The intense restriction exacerbated unsanitary hospital situations and assured infections for sufferers.

“It was devastating to see just how much worse it can get,” Abughnaim mentioned, recalling bugs all around the medical amenities and well being care staff needing to take away maggots from intubated sufferers who couldn’t swat them away.

The continuing closure of the Rafah crossing between Egypt and Gaza has been “devastating” for humanitarian work, mentioned Dr. Thaer Ahmad, a Palestinian American emergency doctor who volunteered at Nasser Hospital.

“Medical evacuations are not happening consistently, aid is not getting in at the rate that it needs to get into,” he mentioned. “But also people are not able to move in and out of there, whether it’s humanitarian actors or Palestinians who should be going back and forth.”

Support vans that do enter the territory typically don’t even make it to their vacation spot as a result of destroyed highway infrastructure and the specter of Israeli snipers and drones. The U.S.’s choice to halt funding for UNRWA ― the UN company with the means to distribute large quantities of help to Palestinians ― mixed with Israel’s hunger marketing campaign has additionally led to a breakdown of social order when help does arrive.

“We’re now talking a year into this, and people are starving. Well, guess what happens when people starve? They do what they have to do to get food,” Kahler mentioned. “So you’ll see the trucks come in and you’ll see people on top of them with sticks and stuff like that. People say, ‘Oh, they can’t even trust getting aid in.’ Well, of course you can’t. If you starve a group of people, they’re going to do what they need to do when they see food.”

Israel’s offensive has created ultimate situations for an incredibly extreme hunger marketing campaign in Gaza by destroying the land and its agriculture, forcing Palestinians to completely rely on the very help that the army nonetheless gained’t enable contained in the territory. Final month, the U.N. particular rapporteur on the appropriate to meals accused Israel of intentionally ravenous individuals in Gaza as a technique to exterminate the Palestinian inhabitants. Israel has denied the declare.

“North Gaza is still suffering from malnutrition,” nutritionist Rana Soboh mentioned of the territory’s area, the place she lives together with her household.

The person-made famine first turned seen in Gaza’s northern area, forcing many Palestinians to resort to consuming grass, weeds and animal feed for sustenance.

“The body needs protein and multivitamins, calcium, zinc, magnesium,” she mentioned. “If the patient doesn’t have enough protein or calcium ― you know, the bone consists of protein and calcium ― and we need this to improve muscle and improve healthy brain [function]. And here in north Gaza, there’s no sources of protein or calcium, or any multivitamins in general.”

One in 5 Palestinians in Gaza is dealing with hunger, based on the Built-in Meals Safety Part Classification (IPC). The households in Gaza who’re fortunate sufficient to entry meals help normally obtain solely flour, some canned greens and no protein.

Oftentimes, teenagers and adults will give their meals to youthful youngsters within the household, on condition that acute malnutrition is extra deadly for youngsters. Greater than 21,600 Palestinian kids between 6 months and 5 years previous have been recognized with acute malnutrition in Gaza, and at the least 28 kids youthful than 5 have died of it, the U.N. reported final month.

“Children suffering from malnutrition are more likely to experience delays in physical and congenital development, which can negatively impact their academic performance and future opportunities,” Soboh mentioned. “On the other hand, for adults, malnutrition can weaken the immune system and increase the risk of chronic disease, further straining the health care system.”

Folks of all ages who’re experiencing malnutrition will typically present seen indicators of weight reduction, weak spot and breathlessness. Because the months move, medical doctors will discover that malnourished sufferers typically have anemia, muscle losing, water retention and a compromised immune system that makes it simpler for them to get infections and more durable to battle them off. Malnourished kids, particularly, will expertise stunted development and the lack to focus. In extreme circumstances, they’ll develop a distended abdomen and swollen legs, in addition to modifications in pores and skin pigmentation.

Kahler labored with UNICEF earlier this yr to arrange a vitamin stabilization website in Rafah. The method of re-feeding relies on simply how severely somebody is malnourished, he mentioned.

“It’s an inverse relationship between how sick you are and how fast you receive,” Kahler informed HuffPost. Although seemingly counterintuitive, individuals who have been malnourished for extended intervals of time mustn’t eat rapidly when meals turns into out there. Kahler says some of these sufferers might want to eat very slowly to be able to recuperate.

“The other thing that happens there is the gastrointestinal system,” Kahler defined. “The lining has sloughed off for so long that it won’t digest the stuff, so they’ll just pass through.”

In Gaza, malnutrition is disproportionately affecting pregnant girls and new moms, based on medical staff within the war-torn space. Many pregnant girls who’re malnourished will both give start prematurely and even lose the child because of the lack of micronutrients, based on Soboh.

“Malnutrition led to widespread spontaneous abortions, underweight newborns and an inability of new mothers to breastfeed. This left their newborns at high risk of death given the lack of access to potable water anywhere in Gaza. Many of those infants died,” American medical staff testified in final week’s letter to the White Home. “In Gaza we watched malnourished mothers feed their underweight newborns infant formula made with poisonous water.”

The unfold of illness and the exacerbation of current diseases in Gaza is a direct results of the mix of a man-made famine, inhumane dwelling situations attributable to displacement, the bombing of so-called protected zones and a collapsed well being care system.

Israel’s offensive has destroyed 70% of Gaza’s sewage pumps and all 5 wastewater remedy crops whereas blocking exterior water provides, decreasing the quantity of accessible water within the territory by 94%, based on a July report by Oxfam, a coalition of anti-poverty organizations. Palestinians now get about 1.25 gallons of water a day per particular person, slightly below a 3rd of the really helpful minimal in emergencies and the equal of lower than a single bathroom flush.

Due to the shortage of water and sanitation infrastructure, 28% of Palestinians have fallen severely in poor health from simply preventable ailments, Oxfam mentioned. Households with out fundamental hygiene reside in shut quarters with no working water or bogs, in tents that sit subsequent to massive piles of sewage and trash.

“I want you to put yourself in a place where you actually can smell the rot, feel the crap on your skin because you haven’t taken a real bath in six months, taste the crap that’s in the air,” Kahler mentioned. “With all those tons of bombs, what’s in the air, let alone on the ground ― these are old buildings, there’s asbestos in the air.”

Greater than 995,000 Palestinians have been recognized with acute respiratory infections and greater than 577,000 have circumstances of acute watery diarrhea, based on the U.N. Tens of 1000’s of Palestinians have additionally skilled jaundice, bloody stools, hepatitis A and scabies. Medical staff have scrambled to distribute vaccines in Gaza after excessive concentrations of poliovirus had been discovered within the sewage, and a case of polio was detected in a 10-year-old boy this summer time.

“If measles comes into a camp of malnourished kids, that’s when measles is more likely to kill [part] of the population. And God forbid cholera ever gets introduced into the general population in Gaza right now,” Kahler mentioned. “Once it’s in there, it doesn’t go away. That’s the other thing with [cholera] ― if you bring it into virgin soil, even when you stop the outbreak, it’s still there. This is why you still have recurring outbreaks in Haiti right now.”

The army offensive has additionally made it unimaginable for Palestinians with current long-term diseases, similar to most cancers or Sort 1 diabetes, to get the remedy they want. Most hospitals not have specialised wards, and the help blockade has prevented mandatory remedy from getting in, primarily turning remedy for some sufferers into hospice care.

“We worry that unknown thousands have already died from the lethal combination of malnutrition and disease, and that tens of thousands more will die in the coming months, especially with the onset of the winter rains in Gaza,” the medical staff mentioned in final week’s letter. “Most of them will be young children.”

One of many longest-term well being points that Israel’s yr of assaults may have on Gaza is the intense psychological harm dealing with each Palestinian, lots of whom had been already experiencing issues with their psychological well being on account of a 17-year blockade on the territory and the generational trauma of being below occupation for 75 years.

“In this situation, in this population, resiliency is resistance. So love is resistance,” Kahler mentioned of the Palestinian individuals.

Due to the help blockade, many sufferers not have entry to medicines which can be mandatory to handle psychiatric points like schizophrenia and bipolar dysfunction. And all of the well being care staff who spoke with HuffPost concluded that each single youngster in Gaza has ongoing traumatic stress, manifesting in a spread of behavioral and bodily issues, together with dissociation and psychological exhaustion.

“I get children coming into the emergency department all the time saying things like, ‘I’m just tired. I’m fatigued,’” Abughnaim mentioned. “You know, it’s not just the heat exhaustion, it’s not just the heat stroke. It’s also psychological fatigue, it’s psychological trauma. And these are things that I can’t necessarily fix with an IV and some lab work and all that.”

With households continuously working in survival mode due to the mass dying and displacement, kids may also present indicators of shock and regression. A Gazan youngster’s sense of stability, which is vital to sustaining good psychological well being, is virtually nonexistent when households are being forcibly evacuated a dozen occasions. Compounded by malnutrition, that type of stress can result in bedwetting, an irregular stage of clinginess and an incapability to specific themselves, Kahler mentioned.

“We’re talking about children writing their wills. They have to take care of their younger siblings and at the same time try to make a living, try to bring water, try to bring some food for the family,” mentioned Dr. Mustafa Elmasri, a Palestinian psychiatrist in Gaza.

Ahmad recalled a number of situations wherein households within the emergency room would quietly watch whereas he and his colleagues tried to resuscitate a liked one who would find yourself dying.

“By the time you’re done, you’re calling the code and basically calling time-of-death, you look up and you start to realize that the mom, the sibling, the younger brother, they were all watching all of that unfold,” he mentioned. “They were watching this very aggressive and violent resuscitation after this violent moment. And witnessing something like that, I just don’t know how they can survive this from a mental health perspective.”

The Israeli army’s siege has not simply inflicted psychological harm on Palestinian civilians and sufferers, it has additionally affected the well being care staff themselves, lots of them Palestinian, who’ve been working across the clock whereas absorbing an equal if not much more extreme stage of trauma.

“I have dreamed of these children that I deal with at the hospital, and I will never forget their sounds when they’d try to call, ‘Hi, doctor. Hi, doctor, please help me.’ And I cannot stop their pain because there is no painkiller,” Musleh tearfully recalled of her expertise at Al-Shifa. To at the present time, she avoids sleeping greater than a few hours out of concern of extra nightmares in regards to the lifeless. In keeping with analysis, some of these sleep disturbances and recurring nightmares have been related to post-traumatic stress dysfunction.

The medical staff mentioned they expertise insomnia, panic assaults and rage whereas nonetheless making an attempt to carry on to kindness when interacting with households on the well being amenities. Medical help staff from the West, particularly, spoke of the gnawing anger, helplessness and ethical misery all of them felt upon leaving Gaza. The problem of processing these feelings is “eating me up right now,” Kahler mentioned.

Coming again to the U.S. from her most up-to-date Gaza journey, Abughnaim described being the closest she had ever felt to psychosis, unable to satisfy the unimaginable process of compartmentalizing all of the horror she’s seen. However working with a therapist helps her settle for that her feelings are regular within the face of never-ending mass dying.

“As humans, we are programmed to respond to atrocity in this way so that we don’t see it happen again, right? … [That] compels us to make a safer world. And so ignoring your normal response to that is not only unhealthy, it’s unproductive,” she mentioned.

“So if I have to break down on my drive home and pull over to the side of the road and cry hysterically for half an hour, I’m doing that. And it’s not the most productive thing in the world, but I don’t know what else to do with all of the pain inside. I don’t know how to grieve 15-20,000 children.”

Regardless of the medical business’s expectations that medical staff keep apolitical of their work, well being care professionals who served in Gaza say they refuse to take action when the system’s collapse and the help blockade is already political. That is particularly urgent for these staff at a time when the U.S., which is Israel’s greatest ally and the house nation for a lot of help staff, continues to provide Israel the inexperienced mild to proceed its offensive in Gaza.

“If the United States were not complicit in this, and I was not a United States citizen, it would be much easier to bear, frankly,” Abughnaim mentioned, echoing Ahmad’s sentiment that there isn’t any “political will” from the U.S. to really safe a everlasting cease-fire in Gaza.

A everlasting cease-fire is the obvious reply for what must occur to start the rebuilding course of, based on most medical staff who spoke to HuffPost. As a doctor, Ahmad spoke to at the least six U.S. authorities entities, in addition to the United Nations, to argue a case for a cease-fire in Gaza. However on condition that there isn’t any finish in sight to the combating, American medical help staff are pleading for officers to reopen the Rafah humanitarian crossing and permit the free stream of help that may be screened by an impartial inspection group as a substitute of the Israeli army.

“I think we have to acknowledge that the day after cannot look like the day before,” Ahmad mentioned. “There was still a blockade on Gaza. There was still restrictions of goods entering. There was still a high amount of medical supplies that would be rejected by the Israeli authorities. That needs to change.”

A part of a rebuilt well being care system in Gaza should embody remedy for the huge variety of new Palestinian amputees, extra psychological well being help and specialised vitamin rehabilitation, he mentioned.

“To prevent future famine, we have a range of solutions to address the root causes of food insecurity here in Gaza, such as promoting local agriculture through innovative methods like vertical farming,” Soboh mentioned. “Also, supporting small businesses and ensuring a steady supply of essential food items through international aid and local production.”

As a result of the battle has deeply affected Palestinians’ nervous programs, Dr. Nimr Ikram urged the potential of electroconvulsive remedy (ECT) or ketamine-assisted remedy, each of which have proven constructive outcomes for treating extreme melancholy and psychological trauma. Support teams must also financially and educationally help Palestinian psychological well being staff to allow them to deal with their very own neighborhood as a substitute of all the time counting on Western well being care suppliers, he mentioned.

A extra holistic strategy may contain storytelling and singing ― strategies which were utilized by indigenous communities to foster intergenerational therapeutic, based on Mohsin Mohi-Ud-Din, who has been implementing neighborhood areas for Palestinians in Gaza to follow emotional regulation. Mohi-Ud-Din has discovered that Palestinian medical professionals had been capable of cut back their stress after receiving validation from their colleagues within the hospital and that Palestinians of all ages discovered reprieve after doing respiratory workout routines and fascinating in paintings.

“The ground was shaking as we were doing this,” he mentioned of the paintings on prayer rugs, however a mom holding her 3-year-old informed him, “This is the first time I do not feel the war.”

Nearly not one of the Western well being care staff expressed optimism that Gaza’s struggling will finish quickly, however all of them mentioned they draw any hope they’ve from the Palestinian individuals.

“I have no right to not be optimistic,” Kahler mentioned. “If my colleagues in Gaza who can’t get out remain optimistic, then who the hell am I not to?”

Musleh is a kind of optimistic Palestinians. To be able to rebuild Gaza, the worldwide neighborhood should see Palestinians as human beings who even have desires and a proper to dwell in peace, Musleh mentioned, and that’s one thing she mentioned she is going to by no means cease combating for.

“I will never, ever let down my people. I will return and support them. I will deliver care for the people, and I will create new programs and new services for the people there,” Musleh mentioned. “Yeah, sometimes I feel up and down, but I will do my best to serve my people because they deserve it.”

“We will get up and we’ll rebuild. We will rebuild the universities, we will rebuild the hospitals, we will rebuild the health system. Yes, we will.”