From a hospital in Gaza: ‘Please let me die’

Michael Berry is an anesthetist and intensive care doctor. Suheal Khan is an orthopedic surgeon. Edward Brown is a consultant vascular and general surgeon. They recently returned from volunteering in one of Medical Aid for Palestinians’ and International Rescue Committee’s emergency medical teams in Gaza.
Three loud thuds, followed by wailing ambulance sirens.
The Israeli military’s designated “safe zone” sheltering internally displaced people has been hit. And in the next half hour, the emergency room will be full of burnt, dismembered and eviscerated patients, many of whom are children — just like last time, and the time before.
All we can do is prepare in anticipation. We know we’ll soon be overwhelmed. Not many hospitals here can deal with a sudden influx of hundreds of blast-injured patients, especially when continuously deprived of medical supplies as they are.
In the middle of the chaos, one of our local anesthetist colleagues hears his cousin and neighbor have been killed in the latest airstrike, which has hit hundreds of people sheltering in a disused school. He continues working, relieved his wife and sons are uninjured. It’s only later that he recognizes his cousin laying in the operating theater, having passed away during surgery; his body too mangled to have been initially recognized.
Another one of his cousins is killed in the next airstrike on the Al Mawasi humanitarian “safe zone” two days later, after being ordered to evacuate there by Israeli forces. Not long after, another airstrike hits the home next to his, destroying valuable possessions and a mobile phone — his only means of communication, bought at a vastly elevated price. And two days later, he himself is forced to evacuate due to the latest attack on Khan Younis. He has nowhere to go.
It is relentless.
Much has been written about Gaza in recent months — often technical, sometimes passionate, articles describing the widespread destruction of infrastructure and health care facilities, the famine, the horrors of war. And while the resilience of the Palestinian people is widely revered and admired, what we witnessed is a deeply traumatized and exhausted population. People repeatedly displaced, homeless, chased around a destroyed slip of land where no place is truly safe.
What we’re seeing in Gaza is a triangle of death: one of famine, dehydration and disease, with the rise of communicable epidemics — such as Hepatitis A and now Polio — due to poor sanitation conditions and lack of vaccinations for children.
Many of our Palestinian colleagues lost family members during the bombings, only briefly stopping their work to acknowledge the loss. Most haven’t been paid for months yet still come to work;  some don’t even stop to leave the hospital, while their families struggle to survive in ruined buildings or tents without sanitation, in the oppressive heat and humidity.
This, along with constant fears around safety, and the need to organize food, water and firewood, is pushing many to the brink. These health care workers, along with 2 million other Palestinians, need help, and they need it urgently.
The laws that govern war are devoid of emotion but aim to safeguard a degree of humanity — even in conflict. We are doctors, not lawyers, but the legal principle of proportionality appears absent in these recent attacks. And proportionality is critical in determining the legality of an act of war. Killing 100 civilians and injuring many hundreds more to take out one suspected Hamas operative seems excessive compared to the military advantage gained, and it gives some indication of the value ascribed to Palestinian lives by the Israeli military.
Warring parties differ in their perspectives by default, and we don’t aim to take sides. However, it’s beyond doubt that Gaza’s civilian population is trapped and subject to extraordinary, inhumane suffering. It’s also beyond doubt that most injured parties are civilians — women and children. In a short space of time, we all saw far too many broken, burnt, distorted bodies; destroyed families; maimed and orphaned children; shattered futures. War might quench the thirst for revenge for Israel, or fuel the fire of resistance for Hamas, it won’t provide security for either party. All the while, Gaza’s population lurches from massacre to massacre without an end in sight.
The health care system in the Gaza Strip has collapsed and is in free fall. There’s a lack of consumables, drugs and equipment needed to be able to treat multiple mass casualties as well as simpler medical problems that are actually treatable. For example, many patients admitted to the Intensive Therapy Unit were comatose due to lack of insulin to treat their diabetes.
Moreover, many senior clinicians have been kidnapped by the Israeli military, kept in inhumane conditions for months on end, in violation of international humanitarian law. The personnel left behind are often junior clinicians and medical student volunteers.
Looking to the future feels almost impossible here. The reconstructive efforts required for a place reduced to rubble will be colossal. So, too, will be the health care needs: Many survivors will require multiple specialist surgeries to treat complex limb injuries and burns; amputees will need physiotherapy and prosthetics. The everyday health system — including primary care — will need to be rebuilt from scratch; and the mental health burden, often ignored in acute conflict, is vast, with many reporting symptoms of post-traumatic stress disorder, complex grief and depression.
Exactly who will address the extensive health care needs of this besieged population cut off from the rest of the world — and how — is uncertain.
As our first patient from the attack arrives moribund, part of his left leg held on by skin and tendons alone, he whispers before his anesthetic is administered: ” I am tired. I have had enough of war. Please let me die.”
We urge the international and medical community to demand an immediate and permanent cease-fire, and to allow access to the humanitarian aid so desperately needed in Gaza.