Israel begins a ground invasion of Gaza

Injured Palestinians receive medical care in the emergency ward of al-Shifa hospital in Gaza City following an Israeli strike on 5th November

Injured Palestinians receive medical care in the emergency ward of al-Shifa hospital in Gaza City following an Israeli strike on 5th November

“Every day, all day there is bombing all around us. Every hour the hospital shakes from the bombing,” says Dr Mohamed Samir Ziara, a surgeon in Gaza, talking to us in late February 2024. “The sound of [Israeli] drones overhead and bomb strikes is constant.”

On 27th October 2023, Israel announced the start of a large-scale ground invasion of the Gaza Strip. The Israeli offensive was launched in response to a brutal attack on 7th October by Hamas, the militant group that rules Gaza, in which at least 1,200 people were killed and another 240 taken hostage. Israel’s military actions have attracted international condemnation for their seemingly indiscriminate bombardment of civilian areas and the high number of casualties.

Since the start of the war, around 60 percent of buildings in the Strip – which is 140 square miles in size and about as densely populated as London – have been damaged or destroyed. According to Oxfam, between the start of the war and January 2024, an average of 250 Palestinians were killed per day. By mid March, the total number of Palestinians killed surpassed 31,000 according to data provided by the Hamas-run health ministry. Another 70,000 people have been wounded.

In the early days of the war, Ziara worked in the al-Shifa hospital in Gaza City, one of the largest medical facilities in the Strip. But in mid-November he fled south after the Israeli army encircled the hospital. Although hospitals are protected under international humanitarian law, they can in some circumstances lose their protection. Israel has claimed that Hamas was holding hostages in a headquarters below the hospital.

“The situation [at al-Shifa] was extremely dangerous. Drones had started striking the hospital as well as warplanes. All the houses and businesses, all the tents around the hospital, they all burned,” says Ziara. “The displaced people living in and around the hospital were forced to flee – many were injured and many were killed. [A few days later] I tried to return, but was impossible because ambulances could no longer enter or leave the hospital.”

Ziara’s brother was one of those killed. “He was hit in the head; he lost a part of it… He was in the intensive care unit for about a week. We prayed for him. But as a doctor I understood the nature of his injury and that he would likely not survive it.” After fleeing south, Ziara learned that his family home, near al-Shifa hospital, had been occupied by the Israeli army. His uncle and several of his cousins had been arrested and taken to Israel. Their family has not heard from them since.

Al-Shifa is not the only hospital to have been forced to close its doors. Of Gaza’s 36 hospitals only 11 are still at least partially functioning. In those that remain open conditions are dire, with patients treated on corridor floors and basic medical equipment and supplies, including anaesthetics, antibiotics and gauze, often unavailable.

Since fleeing Gaza City Ziara has been working in the European hospital, located between the cities of Khan Younis and Rafah in southern Gaza. It is overwhelmed with patients. “The [number of] cases we are treating exceeds the hospital’s capacity maybe four to five times. All the beds are occupied by injured people. There are no beds for chronic patients [with long-term illnesses], only for the war-wounded,” he says. “Medicines are not available. Antibiotics are not available. Even simple painkillers – Tylenol, paracetamol, ibuprofen – we can barely find.”

As a specialist in plastic reconstructive surgery Ziara mostly treats patients with severe burns as well as wounds involving serious muscle and tissue damage. “In normal times, these are injuries that require a lot of work. The patient would receive months of treatment. Typically, I would see three patients a week with this type of injury. Now I see 300 in a week.” The patients’ injuries are also much more severe. “The shrapnel totally destroys limbs; it cuts right through them, and this causes third- to fourth-degree burns – meaning that burns reach the bone. These are burns that require amputations… I could never have imagined wounds as severe as those I have seen in these last months.”

Bombs are only one of the dangers facing Palestinians in Gaza, however. Since the start of the war, Israel has only allowed a trickle of aid to enter the Strip. According to the Integrated Food Security Phase Classification, one in four households now faces catastrophic acute food insecurity. At least 20 people, mostly children, had died from starvation in the hospitals in the north of Gaza by the first week of March according to Gaza’s health ministry. Israel has said there is “no limit” on the aid that can enter Gaza, but in practice its stringent security checks on delivery trucks mean that only a tiny fraction of what is needed gets through. On 29th February, Israeli forces opened fire on a crowd that surrounded an aid convoy delivering food aid close to Gaza City, the first to reach the district in over a month. At least 118 people were killed in the incident – shot, crushed in the ensuing stampede, or run over by aid trucks. EU foreign policy chief Josep Borrell described the humanitarian crisis in Gaza as “manmade” and accused Israel of using starvation as a weapon of war.

“It’s very difficult to find food, we are living mostly on canned goods. Prices have gone up between four and tenfold. My family manages on just one meal per day… there are many people who can no longer afford to buy food. Most depend on aid, but often it is stolen and resold at astronomical prices. Many go days without eating,” says Ziara. “There are severe shortages of everything – a kilo of onions is now ten dollars or more. Not to mention items needed for basic daily sanitation and other needs, nappies for babies, baby milk, tissues and so on.”

Israel’s blockade on Gaza’s fuel and electricity supply, as well as infrastructural damage to desalination and wastewater treatment plants, mean that there is perilously little clean water. UNRWA, the UN aid agency in Gaza, has reported that around 70 percent of people in Gaza are drinking contaminated water. “There is no water for hygiene or sanitation,” says Ziara.

1.9 million people have been displaced by fighting and evacuation orders”

In the hospital, a lack of water to sterilise equipment can mean the difference between life and death for surgery patients, explains Ziara: “It’s a disaster. Most tools we use for surgeries need to be sterilised, but the filtered water we need to do this is only available at night for limited hours. This means if we use the tools once during the day we need to wait until the next day to use them again. Sometimes we resort to using tools that aren’t meant for that job and that can cause complications for the patient.” In some cases there is simply not the equipment or capacity in hospitals to provide life-saving care.

“There are patients that have developed terrible infections. [Due to the lack of sanitation] we are dealing with bacteria we have never dealt with before. The antibiotics we use to heal or reduce inflammation are not available and it’s not possible to change the dressing and clean the wounds of a patient daily as it needs to be,” says Ziara.

Adding to the unsanitary conditions is the sheer volume of people. Around 1.9 million people – 85 percent of Gaza’s population – have been displaced by fighting and by the multiple evacuation orders issued by Israel’s Defence Force. Most have headed south, swelling the populations of the cities of Khan Younis and Rafah to bursting point. Dozens of people share a single room or tent. Many do not have clothes suitable for the cooler winter temperatures and the makeshift camps often have only a single toilet for hundreds of people, leading to sewage overflows in the streets.

Around 30,000 people have sought shelter in and around the grounds of the European Hospital. “There are displaced people camped on the road, living in makeshift tents made from blankets in the hospital. They are everywhere – every path, every corridor, inside the hospital building and outside of it, everywhere is filled with tents,” says Ziara.

“As you walk through the hospital you hear children coughing and wheezing. There are diseases spreading among them – Covid, Hepatitis A, stomach flus. The overcrowding makes it difficult to move in the hospital… and children run through the corridors searching for food,” says Ziara. “If I told you all the ways that people are suffering, then I would be talking for days.”

See page 12 for our feature on the Israeli hostages

Posted on Friday, June 21st, 2024 - Categories: #53 - Oct-Dec 2023, App Issues.