August 27, 2014

 

Life During Wartime

For 50 days, the Doctors Without Borders/Médecins Sans Frontières (MSF) staff and patients at Gaza’s Al Shifa hospital have lived and worked in a cycle of fighting, ceasefire, and renewed fighting. However, on August 25, an open-ended ceasefire went into effect, bringing a massive sense of relief to MSF teams and to the population of Gaza as a whole. Thought the fighting has ended, activity in the largest hospital in Gaza continues unabated. Until this week the hospital was still receiving people wounded in recent bombings, as well as people injured over previous days who were unable to come for treatment until now.

MSF surgical teams continue to work alongside staff from the Palestinian Ministry of Health at Al Shifa, as they have been doing since the Israeli army launched Operation Protective Edge on July 8. As one MSF surgeon leaves, another one takes his or her place. Maurice, a thoracic surgeon, has just returned from Gaza. "I was operating on patients with chest and abdominal injuries,” he says. “Most were shrapnel wounds. Even a small piece of shrapnel less than 1 centimeter long can tear everything in its path and cause massive wounds to the lungs. More than half of the patients I operated on were women and children. "

Two other MSF surgeons are currently working in Al Shifa, operating on patients with severe burns who require multiple surgeries, doing plastic surgery, and carrying out skin grafts, amongst other things. They are also called on to assist with especially long or difficult operations. The 60-bed hospital receives patients from across the Gaza Strip, and includes six operating theatres, an intensive care unit where burns victims are cared for, and an emergency room. The Palestinian medical staff is very experienced, but a number of hospitals in Gaza have been destroyed or damaged, and the workload in Al Shifa is so heavy that they still need outside support.  

From July 28 to August 10, MSF had three surgical teams working in the hospital, tending to a constant influx of wounded patients during the ground offensive. The emergency room was overwhelmed, as were the operating theaters, with 30 to 40 seriously wounded patients arriving each day.

"Many patients had multiple shrapnel wounds caused by explosions, with chest, vascular and limb injuries,” says Kelly, an anesthesiologist who spent almost four weeks in Gaza. “People in the vicinity of an explosion are burned by the heat, while the blast destroys their lungs and shrapnel penetrates their body. The shock wave can destroy the leg bones of a person who is standing, and both legs then need to be amputated—it's terrible, but there’s no other solution."

In seven weeks, MSF sent 37 international staff to Gaza, including surgeons, doctors, nurses, administrators, and project coordinators. Currently MSF has two surgeons, two anesthesiologists, and one intensive care nurse working in the hospital.

Following Up

MSF also runs a clinic in Gaza City providing post-operative care to patients who have undergone surgery, who come to have their dressings changed and to attend rehabilitation sessions with a physiotherapist.

Like Al Shifa, activities in the post-operative care clinic over the past seven weeks were also affected by the frequency and intensity of attacks. At the height of the fighting, the clinic closed for 11 days, as it was impossible for patients to reach the clinic on their own or to be transported by MSF car.

During this time, the team provided dressing kits for patients. When the clinic reopened, 20 to 40 percent of patients were able to come for their appointments. A number of patients, however, have still not been traced. Now the clinic is full. "It's like a beehive,” says Dr. Abu Abed, an MSF doctor. "As well as our former patients, we have been caring for new patients who were injured during the war. We saw more than 100 new patients between July 1 and August 25. "

The medical aid MSF is providing in Gaza takes a number of different forms. In addition to working in Al Shifa hospital and the post-operative care clinic, MSF has also ​​donated drugs and medical supplies to the central pharmacy in Gaza, to Al Shifa hospital, to Nasser hospital in Khan Younis, and to Kamal Edwan hospital in Beit Lahiya.

Working Together

This aid was provided in no small part due to successful collaboration between MSF teams and the Palestinian Ministry of Health. With the blockade cutting off the entire population of Gaza from the outside world, in recent years Palestinian medical staff have been deprived of opportunities to share skills with international colleagues, to gain practical experience, or to travel to medical conferences abroad. As a result, they have been appreciative of the chance to learn new surgical, anesthetic and medical practices from MSF staff.

MSF currently has 50 staff working in Gaza, 40 Palestinian and 10 international. MSF also works in the West Bank, running a psychological support program in the governorates of Hebron and Nablus.

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