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Inside Gaza: “Staying alive is only a matter of luck”

An MSF aid worker who just returned from Gaza reports back on the situation on the ground.

Palestinians search for survivors in the rubble left by an Israeli airstrike on Gaza in October 2023.

Residents search for survivors in the destruction caused by airstrikes in Gaza. Palestine 2023 © MSF

Palestinian Doctors Without Borders/Médecins Sans Frontières (MSF) staff have been working in Gaza’s hospitals and clinics throughout the conflict, working tirelessly to keep saving lives amid horrific conditions, including lack of water and electricity, that have contributed to the spread of infectious diseases. 

For years, international MSF staff have aided Palestinian colleagues in providing health care in Gaza, though many of them were evacuated soon after the war started. In November, MSF sent a new team of international staff members to support surgical care and burns treatment. Among them is Ricardo Martinez, a logistics coordinator who recently returned after four weeks in Gaza. In this Q&A, he shares what he saw on the ground in Gaza during his time there.

We know that the humanitarian situation in Gaza is horrific. What did you witness personally?

An immediate and sustained ceasefire is needed in Gaza, but I also insist on raising the alarm about the lack of water and sanitation. At this point, I'm fairly certain that, in the long run, it could be as dangerous as the bombings and could kill as many people. 

The water system isn't working anymore—it has completely collapsed. People are being pushed to the limit, having to fight for their survival. At most, people have one liter of water per day—that’s for drinking, washing, and cooking. There is only one shower for 500 people. Those able to take showers are considered lucky. In the south of Gaza, our teams are distributing 50 to 60 cubic meters of water a day, but this is only a drop in the ocean given the immense need. 

A Palestinian woman holds a jug of water after filling it in Gaza during Israeli siege
Palestinians fill up jugs of scarce water on October 20. Palestine 2023 © MSF

In the south of Gaza, places are so overcrowded that it feels like you are in a packed football stadium. With so many people using the same few toilets, and with no fuel for pumping the water, I've seen sewage flowing into the streets where vendors are working, where children are playing and splashing in the filthy black water. You can only imagine the impact on people’s health

Whatever people want to do, they have to plan ahead of time; you must think, plan, and organize—and then you will find out if you are lucky or not. You want to go to the toilet? When and where do you go when there are hundreds of people queueing for one toilet? I don't think I need to go into further details of how people are getting by.

What is the fuel and electricity situation in Gaza?

In some places, there is [still] no fuel or electricity. It's impacting everything. Without fuel, the grinding mills are not working, so nobody has wheat—no wheat, no food. Trucks coming from Egypt are offloading aid to trucks in Gaza, but without fuel, these trucks are unable to move and distribute the aid.

We have seen the devastating loss of life caused by the lack of fuel in hospitals, with generators not working and doctors unable to save people's lives. Hospitals have become villages, with people living in crowded corridors

A Palestinian man charges his phone on the hood of a car in Gaza, where electricity has been cut off by Israel.
Gaza has been under an electricity blackout for much of the past six months. Palestine 2023 © MSF

On December 3, MSF had to close its clinic in the southern city of Khan Younis after an Israeli evacuation order. Can you describe what happened?  

The Israeli forces announce evacuation orders through a military website that they launched on December 1. One day, an area on the map will be declared a ‘red zone’—meaning that it will be targeted. Let's keep in mind that there is barely any electricity in Gaza, meaning no internet. How can you find out if you have to leave? 

We knew it was just a matter of time before the area we were working in would receive an evacuation order. We had discussed it just two or three days earlier. Then, on December 3, we were forced to close our clinic and leave Khan Younis. That morning, I was in charge of the logistics to get us several kilometers towards the west. For me, this was the most painful day I experienced during my time in Gaza. 

Who could have told us not to go there because it would be bombed? No one. Staying alive is only a matter of luck.

I started packing the cars, taking care of the logistics and making sure that everything was ready. It was heartbreaking—running away and having to look at Palestinian colleagues and neighbors who had been with us all the time, helping us with everything, and knowing that most probably I would never see them again. There was no time to thank them all for the good things they had done for us. To tell the truth, I was ashamed.  

But in reality, no place is safe in Gaza. I remember revisiting a place with my colleague Omar, a Palestinian logistics supervisor, that had been destroyed since our visit the previous day. He said to me: “Look at this, Ricardo, we were just here yesterday and look at the rubble now.” Who could have told us not to go there because it would be bombed? No one. Staying alive is only a matter of luck. This was one of six different places that were destroyed just after we had visited them—six places demolished into rubble. Schools: gone. Offices: gone. Private houses: gone. Water plants: gone.

Displaced people and patients crowd the halls of hospitals in Gaza.
The hallways of Al-Aqsa Hospital. Palestine 2023 © MSF

What was the reaction of people in Gaza to the temporary truce that broke on December 1?

I remember very well when the pause in bombing started. That morning, the minute the clock turned seven, I started to hear chanting and singing and cheers of joy. That day I finally cried, I cried because I saw them so happy. But that only lasted for a few short days. The truce ended at 7 p.m., and already by 7:03 all hell was unleashed again. 

For a short period, people were able to visit their families. This was the most important thing for everyone. Some went to the north of Gaza and took the time to spend several days with their loved ones. 

At the same time, it wasn’t completely over as others took the time as an opportunity to bury the dead. Many went to collect the corpses of people whose bodies were rotting in the streets—some for almost two months. Can you imagine the smell and the pain? 

Palestinians line up on a rubble-strewn street in Gaza.
Palestinians wait to buy food in Gaza on October 18. Palestine 2023 © MSF

MSF teams are providing emergency medical care and donating medical supplies to hospitals and clinics in Gaza. Can you describe how MSF is managing to provide aid in these circumstances? 

When I arrived in Gaza, it became very clear that whatever impact we are having is solely thanks to our dedicated Palestinian staff. Since day one they have been doing everything to keep saving lives. They’re truly bringing hope in the middle of a nightmare. 

Most of our staff have been displaced from their homes and have lost loved ones. Tragically, the brutality happening now isn’t new to them—they’ve experienced it before. They know they could die at any given moment but they still greet you each morning with a smile. And when you ask how they are, they reply: “I’m okay, I'm still alive.” 

I will never forget when we were still working in our clinic in Khan Younis. I would awake at 6 a.m. and go to the clinic. Each morning, our staff member Ishaq would open the door and greet me with a huge smile on his face. I would apologize for waking him up but he would reassure me: “No, no, Ricardo, I woke up half an hour ago. Welcome! I have been waiting for you.” 

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Like Ishaq, many of our staff members are making sure that those of us who come from outside Gaza have everything we need, from helping us charge our torches to having food and feeling welcomed. They care not only for their patients, but for everyone around them. They will tell you: “I want to help you—I must help you—because I want to help my people.” 

At the same time, they keep asking: “Why? What did we do to deserve this punishment? Why has the world forgotten us?’” 

MSF has repeatedly called for an immediate and sustained ceasefire to prevent more deaths in Gaza and has called on Israeli authorities to lift the siege to allow the sufficient and continuous flow of aid workers and humanitarian supplies into Gaza, including essential items such as water and fuel. Indiscriminate and relentless attacks must stop now. Forcible displacement must stop now. Assaults on hospitals and medical staff must stop now. Restrictions on aid must stop now. 

How we're responding to the war in Gaza