A doctor's account from Gaza (podcast)

AVRIL: Hello and welcome. I'm Avril Benoit, CEO of Doctors Without Borders USA. Today, we're looking at Gaza through a humanitarian lens. More than a year and a half of war has destroyed thousands of lives. It's forcibly displaced over 1.9 million people, often many times. Much of the Strip lies in ruins and humanitarian needs are more dire than ever. With me is Dr. Aqsa Durrani, a US-based physician and pediatrician, whose latest assignment was at our field hospital in Der al-Balah in central Gaza. Aqsa, thank you for sharing your experience with us.

AQSA: Thanks for having me.

AVRIL: Now everybody knows that Gaza is incredibly dangerous. It's a time of horror there. Why did you decide to take this assignment?

AQSA: I think that our organization has a storied history of going where people need us the most, and that's why I'm proud to work with MSF. But I can't imagine a place in the world right now where we're more needed than in Gaza. And I think the personal risks that we take pale in comparison to the risks that our Palestinian colleagues are taking every single day when they're, you know, facing bombardment, facing displacement, and still going to work. So it was important to me to show up and to be there and as part of our shared humanity, to provide care and to use the skills that I've been given to be with them in this time.

AVRIL: It does cross my mind also as a leader sometimes that I should always be willing to go where we have teams on the ground, if only to help and to show solidarity, but also to confirm that we're in it together and we will take the risks together. But we will talk about the security environment in a moment. But maybe you can just help us imagine what it was like coming into the Strip as you're entering for the first time to reach the location of your assignment for the weeks that you were going to spend there.

AQSA: So I had spoken to several of my colleagues who warned me that it would be unlike anything I had ever experienced. And despite having done this for years and years, that I should be prepared that I may have a reaction that I didn't expect. And, you know, I had spent over a year and four months at that point watching video upon video of what the destruction was like. But my colleagues were right. You know, when I entered, we drove through Rafah in order to arrive at our destination and when you look around you, it is just dystopian. It's really hard to describe because I did indeed have a reaction that I didn't expect. It was a visceral reaction that I still carry with me because it's really hard to believe that we have allowed this to happen, that this is actually still happening. As you drive through, you see building after building leveled. It's very clear upon the first moments of entering that it's systematic that it's that it is an annihilation. And I had worked in, you know, places that were affected by natural disasters, for example. But what really struck me was this was a manmade annihilation.

AVRIL: And we all know Rafah because that was the place initially that people were told to go to when they were evacuated from different locations, especially in the north. And so is that is that the way it was all along as you as you reached Deir al-Balah, where you were based?

AQSA: What we noticed was that as you start to get closer to Deir al-Balah, you see a little bit more signs of life, but still, you know, destruction all around you and very few buildings that are still standing. And this was in what was so-called the safest area and the destruction and that the destruction in the north is actually even more, you know, stark than the destruction that we witnessed in Rafah. So it's very clear that, you know, the area that is even livable is ever shrinking, even the area that we were in

AVRIL: And so your role there then when you got to this field hospital was medical activity manager. What kinds of things were we treating there?

AQSA: So I worked in a field hospital. It's a trauma surgical hospital. We treated patients of all ages who were affected by surgical trauma. So that meant burns, that meant injuries from airstrikes, fractures and gunshot wounds as well. And then we also saw infected wounds, infected, you know, open fractures that had been infected as well. So the vast majority of patients that we saw, even though this wasn't a pediatric hospital, it really struck me as a pediatrician that the vast majority of patients we were seeing were actually women and children. And it was just another example of how this is affecting the community in a way that is unspeakable when people have catastrophic trauma injuries or burns that normally you would be in hospital for quite a long time, sometimes months post op care and infection control and all of these things. And so at what point do you discharge people and what are they being discharged into knowing that so many shelters are destroyed, there isn't clean water for cleaning, so many medical supplies. Even we've heard that gauze was lacking. All the all the things were lacking.

AVRIL: So what is the environment of a patient who's actually has to leave the hospital because you need the space for other patients?

AQSA: So I mean, I think that the first of all we were treating burns in a field hospital, which is you know as you referred to the infection prevention and control practices, that's something that is far less than ideal and in a situation where there is scarce nutritional sources available for the patients where they're at higher risk for infection. So while we were treating them in in the field hospital or in Nasser Hospital where some of our teams are also treating burns, we had limited ability to even provide pain control for painful dressing changes. We had limited ability to limited supplies that we had to worry about. You know, if the siege or blockade on supplies continues, will we even have enough supplies to treat our patients? And when we discharge them, they're being discharged into crowded, unsanitary conditions where, you know, we ended up keeping some, particularly some children longer because we were worried that if we discharge them, that they would just, you know, get further infection or be further at risk when we discharged them into, you know, a tent with squalid conditions. You know, and we were only able to reach the patients who were able to reach us, you know, and there are patients who I'm sure did not. We're not able to reach us because of the lack of security and because of bombardment and forced displacement that was just made it impossible for probably the most vulnerable patients to move.

AVRIL: So you've got people trying to leave places where they're sheltering in whatever shelter they have, whether it's a tent or a crumbled building remnants and they have to go through what to then reach the hospital. What are some of the obstacles before they actually find their way to medical treatment?

AQSA: So as an example, one of the patients that we had who was from Jabalia camp in the north, she was, you know, a woman who was around 30 years old and has three toddlers or younger children. She came on a tuk-tuk with an open fracture and, and just severe injuries to be able to get to us. But she describes her journey coming to our hospital and it took, it took over a day for her to travel this very small distance with those injuries. And she while she was en route, she had to pass through evacuation zones that were under bombardment. And then they had to stop and shelter to try to avoid the areas that were under evacuation order. There is no way to avoid those areas when you're trying to come to our hospital because there's so much of the Strip at this point. Around 70 percent of the Strip is under evacuation order so to move around is always risking your life no matter what. And she had to make this horrifying decision of leaving her toddler children to seek care. And she has not seen them in a month and a half because for them to reach our hospital again under those conditions, she doesn't want them to risk their lives. And she is not able to, you know, we are not able to discharge her yet because her injuries are so severe. So these are the kinds of life or death decisions that people are making on a daily basis, even when they're trying to seek care.

AVRIL: Yeah, it's, it's it, it sounds absolutely harrowing. And then also within the hospital, you're dealing with such pressure, not only the medical urgency, understaffed, under resourced, the whole, the whole environment is, is at a certain point cut off from receiving all the medical materials and staff that it would really need all the, the, the, the crossing points shut at a certain point while you were there. But you're also dealing with just the, the heartache, I would imagine of it. You treated children who had lost one or both parents and mothers who had lost their children. The mental health toll on those survivors must be enormous.

AQSA: Yeah, I mean, I it was it was non-stop ... It was really non-stop that we had situations like this. You know, I had a mom wake up from surgery frantically saying, please help me, my children, I need to find them. And, and they're at Al-Aqsa Hospital. Can you please find them? And, you know, so we contacted Al-Aqsa Hospital and we learned that every single member of her family had been killed. That included her children who were 5, 3, and 9. And we had to, to tell her that her husband and her children, we're no longer, you know, we're no longer with us. They had been killed in the air strike. And, you know, and then you move on. And I, and for me, I, I think as part of my role, I had to provide people with permission to be able to leave the hospital, if they needed to leave the hospital for any reason and if to see, to make sure that it was safe. And I had to provide an uncanny number of parents permission to go say their final goodbyes to their children, you know, to go attend the funeral or to go to the morgue at one of the other hospitals to see them and say goodbye to them. And, you know, and the children who lost their parents, they're, you know, there's absolutely nothing that you can do. And I, I say this as a pediatric ICU doctor, there's nothing that you can do to replace the love of parents. You can bring their aunts, you can bring their uncles. There's absolutely nothing that we can do for them. And that's heartbreaking.

And, you know, sometimes we would see them, you know, we would see the children who, whose parents did survive. For example, we had one child who had so much, so, so much anxiety. He was screaming over and over and over again that he just wanted to be with his mother. And I, I was so worried that he had lost his mother in the air strike that he was injured in. But we, we learned that she actually had survived and she was at another hospital with the sister who was in another ICU. So I was able to bring that child's mother to our hospital. And when he saw his mother, the say, you could just see that he immediately calmed down. There is no medication in the world that can do that. And I had so many patients that I'm not able to to do that for because they lost their parents and we couldn't bring them. And that's the toll that these children are bearing. The other factor that's been so heartbreaking has been just the lack of food. We, we all know from our experiences, people in a medical organization, how much nutrition is important for healing. And even our own staff are, are now down to one meal a day because during the time you were there, the, the Israeli authorities imposed, you know, another very severe, severe blockade.

AVRIL: And so for such a long time, there was just nothing, nothing coming in and, and nothing to eat. How does that affect patients and their families?

AQSA: It's, you know, however, I think that there's really, it's just another example of how there is no aspect of life in Gaza that's not touched by the violence. Absolutely none. And again, it was one of those scenarios where like as a doctor or just as a human, this is the first time that I've had to tell people or tell my patients that I didn't have something that I knew was just a few miles away. And that is torture, you know, to be able to just have to tell a mother who is begging for just a little bit more food for their children that they. We don't actually have it. But it's not because we don't have it. We actually do have it. It's because it's being deliberately blocked from us. And that that feeling of just, yeah, just having to be the intermediary person who has to say we don't have, we don't have this thing that's right there is, is unconscionable. It's the first time as a humanitarian that I've experienced that.

And for the mothers, you know, again, who are mothers and fathers and children who are, who are hungry, it's just another aspect of how of theirs, of their suffering. And they are each day, you know, trying to survive. And here they are injured from an air strike or injured from burns and suffering and pain. And then they have the pain of hunger on top of that. And, you know, at one point, yeah, while we were there, we had one meal that we could offer to patients. And for mothers and children, it was 1 portion, 1 portion that we could give for because we just didn't have enough. The toll that that's taking on them as in the long term, there's no words for the layers of the trauma that they're experiencing.

AVRIL: I would imagine that it's, it's hard for a child to understand the, the deliberateness of their, the hunger that they feel, that so much of the suffering is, is deliberate.

AQSA: Yeah, I, I think that, you know, they don't, you know, maybe they don't understand it, but certainly it will live with them. The trauma will live with them and their parents understand it. And the parents who, who are, you know, having to look at their starving children and, and having to answer to them when they ask for food.

AVRIL: Now as a long time humanitarian, you've worked in many places where communities are under attack, but also health care, hospitals, ambulances, clinics are attacked. We in MSF in Doctors Without Borders, we've seen it in Ukraine, we've seen it in Sudan and Democratic Republic of Congo, South Sudan, Syria, even Afghanistan and Yemen. What makes Gaza different in your experience as far as that goes?

AQSA: And in terms of that, I think it's the incessant and deliberate and systematic attacks. I yeah, you're right that we have worked in other places where it's where it has also been deliberate, but it was systematic. I mean, there's a systematic destruction of the healthcare system in Gaza. So the care that we are able to provide is subpar because. There are no fully functioning hospitals left in Gaza. That systematic nature and the fact that we have had to reduce our activities in the, you know, two hospitals were bombed while I was there, and we've had to reduce our activities when the community and the people need more care. And so the fact that we're being pushed and pushed and pushed and the community is being pushed and pushed again, that they're not able to seek care, even hospitals are not safe. That is unique. The systematic nature of it is unique. I worry that it's really changing the world forever in a way that, you know, if we don't see that people are respecting the safety of hospitals, where do we go from here listening to all of this?

AVRIL: And of course, for those of us who've been following what's happened since the horrors of October 7, all this destruction, all this suffering, all the killing, it, it's so dark. I would imagine now that you're back in the safety of the US, you're among your people, your loved ones, you're processing. Is there is there any image or moment that you conjure that gives you some sense of lightness amidst all the darkness that gives you some sense of hope?

AQSA: It's hard, you know, I would say that and I'm trying not to center my own experience, but I do want to share this that, you know, although I have worked in a lot of places where I have been around bombardment and armed conflict, this is the first time that I'm coming back and I'm feeling viscerally whenever a plane or a helicopter comes by, you know, this like visceral reaction. And it's hard not to think of the children who are there who are internalizing this trauma and who are not able to have that breath of fresh air and who don't have the privilege of coming back here to to safety. So I was in, I did have a lot of moment and I still have a lot of moments of despair because it's hard to, it's hard to reckon with these realities being coexisting. But I do, you know, I take hope in the fact that the Palestinian colleagues that I worked with are amongst the most compassionate and, yeah, just amazing people that I worked with, I've ever worked with. And I think that who am I to have any despair if they come to work every day and provide care so beautifully, so kindly, so compassionately, and that they still have some hope. So if they have hope, who are we not to have hope? Because they're, you know, they're the ones who are living it. What they really want is just for this to stop and then we can take their hope and help them to rebuild. 

AVRIL: And that will take all of our energies as well. Aqsa, thank you so much. I, I know it's not easy to be asked to, to, to describe what you went through, but I know that you, you felt so strongly that you wanted to do it. So I, I appreciate that you took the time. Thank you, Dr. Aqsa Durrani, pediatrician and medical activity manager.

For more information about Gaza, you can check out stories that we have on our website, doctorswithoutborders.org. And also check out the notes for this episode to find other ways to connect with MSF on social media. This is Humanitarian Lens, a podcast of Doctors Without Borders USA. I'm Avril Benoit, till next time.