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.
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 lays in ruins and humanitarian needs are more
dire than ever. With me is Doctor Aqsa Durrani,
AUS based physician and pediatrician whose latest
assignment was at our field hospital in Der Al Bala in
central Gaza. Aqsa, thank you for sharing your
experience with us. Thanks for having me.
Now everybody knows that Gaza is incredibly dangerous.
It's a time of horror there. Why did you decide to take this
assignment? 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 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 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,
you know, be with them in this time.
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 to help and to show solidarity, but also to to
confirm that we're in it together and we will take the
risks together. But it 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, 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.
Yeah, so I had, I had spoken to several of my colleagues who who
warned me that it would be unlike anything I had ever
experienced. And despite having done this for
years and years, that I, I should be prepared that I may
have a reaction that I didn't expect.
And, you know, I had spent over, over a year and four months at
that point watching video upon video of what the destruction
was like. But my colleagues were right.
First, we we drove through Rafa in order to arrive at our
destination and want, you know, 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 that we have allowed this to
happen, that 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 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 man made annihilation.
And we all know Rafa because that was the place initially
that people were told to go when they were evacuated from
different locations, especially in the north.
And so is that the way it was all along as you reached Der Al
Bala where you were based? What we noticed was that as you
start to get closer to Der Al Bala, it's a little bit, 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 the
destruction in the North is actually even more, you know,
stark than the destruction that we witnessed in Rafa.
So it's very clear that you know, the the area that people
that that is even livable is ever shrinking even the area
that we were in. And so your role there then when
you when you got to this field hospital was medical activity
manager, what kinds of things were were we treating there?
So I 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 things were lacking.
So what is the environment of a patient who's actually has to
leave the hospital because you need the space for other
patients? Exactly.
So I mean, I think that the first of all, we were treating
burns in a field hospital, which is, you know, as 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 the 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 we if the siege or
blockade on supplies continues, will we even have enough
supplies to, 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
discharge them into, you know, a tent with squalid conditions.
You know, and we were only able to reach the patients who are
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 for
probably the most vulnerable patients to move.
Yeah, 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? So as an example, one of the
patients that we had who was from Gevalia camp in the north,
she was a woman who was around 30 years old and has three Todd,
you know, toddler 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 on 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% 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.
Yeah, it's, it's, 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 the mental health toll on those survivors must be
enormous. Yeah, I mean I it was it was
non-stop. Sorry, I need a second.
It was really nonstop that we had situations like this.
You know, I had a mom wake up from surgery frantically saying,
please help me, my, 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, 3:00 and 9:00. And we had to to tell her that
her husband and her children were 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, 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, that has that we 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, when he saw his mother, the say, you could just
see that he immediately calmed down.
There's 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 1 meal a day because during the time you were there,
the, the Israeli authorities imposed, you know, another very
severe, severe blockade. 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? It's, you know, Avril, 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, to, 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 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 I've had 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. 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. 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. Now as a 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 in
Ukraine, we've seen it in Sudan and Democratic Republic of
Congo, South Sudan. We have a well Syria, we had a
lot of that, even Afghanistan and Yemen.
What, what makes Gaza different in your experience, as far as
that goes? Yeah.
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, 2 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. And it, it, it's really, I, I, I
worry that it's really changing the world forever in a way that,
you know. If we don't, if we don't see
that people are respecting the safety of hospitals, where do we
go from here? Listening to all of this, and of
course for those of us who've been following what's happened
since the horrors of October 7th, 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 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?
It's hard, you know, I would say that and I don't, you know, I
think 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 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. I still have a lot of moments of
despair because it's hard to, it's hard to reckon with these
realities being coexisting. 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.
And you know, yeah. And that will take all of our
energies as well. AXA, 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.
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 Mitzes Alfronzier on social media.
This is Humanitarian Lens, a podcast of Doctors Without
Borders USA. I'm Avril Benoit, till next
time.