I remember that during Operation Cast Lead, the winter 2008-2009 Israeli offensive on Gaza, I would pressure my father to show me the bullets and shrapnel that he removed from the bodies of those he treated. He often tucked them in a handkerchief and hid them in a kitchen drawer.
During those three weeks, my father spent most of his time at the hospital and we saw only fragments of him. My father, Basil Baker, is a neurosurgeon, a Cairo graduate who works at al-Shifa hospital, the largest in the Gaza Strip. We live just across the road from this hospital, except that now I live in London.
Though Dad has been a doctor for as long as I can remember, I had absolutely no idea about work dynamics in the hospital until I interviewed him on Sunday.
Israel continues to pound the Gaza Strip. The death toll rises so rapidly that I find it impossible to pen a number as I write, and as readers read.
I asked my father to describe a typical day in the hospital, urging him to tell me more about how work is organized and divided among the various sections at a time like this.
“In emergency situations like this,” Dad explained, “doctors in the hospital are divided into two groups; each works on a 24-hour shift. When one group has completed its shift, it hands work over to the second group so that the first one can rest. We go to the hospital at 9:00 in the morning to replace the former group.
“First, we go over every patient we have; we make sure every patient has all she or he needs, take notes, do x-rays, blood tests and all this stuff. Then we try to reorganize the various sections — sections where low-risk patients are housed are released or transferred to smaller hospitals to allow room for others.
“Having finished the morning check-up, we write a report based on the notes, and submit it to the hospital administration. The administration uses this report to decide which patients need to be transferred to hospitals outside of Gaza, to present it to [foreign] delegations, and to decide on who will be moved to smaller hospitals. This is basic work. Other than that, we work with the cases we receive during the day.”
Having scolded my younger sister for teasing him as he spoke, Dad then moved on to describe what takes place when casualties arrive at the hospital.
“There always is one doctor [accompanied by nurses] available at the hospital reception to provide first-aid once the wounded have arrived. This doctor does x-rays then transfers each case to the section most able to treat the particular injury. So when there is an emergency, someone receives [casualties], someone performs surgeries, others nurse patients already treated, and so on.”
Here, Dad took a few seconds to think, as if weighing his words before he pronounced them. Knowing how concerned he always is with precision, I let him take his time.
He carried on: “When there’s what we call a mass casualty, which means that many surgeries need to be performed at the same time, the whole group on the shift is exhausted and we sometimes call up members from the other [non-working] group.”
Dad has always been critical of the medical system in the Gaza Strip, both under the Palestinian Authority and later under Hamas. He often complains about inefficiency and conflicts with and within the administration. I was curious about this bit, given the immensity and gravity of the conditions under which he and his colleagues nowadays work.
Dad looked particularly heartwarmed upon hearing my question.
“We all divide the work amongst ourselves. If time allows, we ask each other to go rest for an hour or two. Of course, there isn’t enough space in the hospital for everyone to sleep; it is not equipped to accommodate such a large number of doctors [and nurses] available in the hospital at the same time. So if ten of us are tired, for example, two sleep at a time while others work, then those who slept work, and those who worked, sleep.
“We have our iftar and suhour [Ramadan meals] together. In fact, at times like this, conflicts and sensitivities disappear. All doctors here leave their families behind and spend their time in the hospital. Doctors, on their way to the hospital, are exposed to danger, but they all do it nevertheless. It is not easy for us to leave our families behind. Khalas [that’s it], it’s a human duty, so none of us thinks twice [about going to the hospital].”
“Everyone is working”
I was blown away. Palestinian government servants in the Gaza Strip, including those working in the health sector, have not received their salaries for several months now. This is widely attributed to the Fatah-Hamas divide which seems to afflict the newly-formed “unity” government. I asked my father whether this has any impact on doctors’ work and morale.
“Banks are closed,” he said. “Those who are on the Ramallah [Palestinian Authority] payroll did not receive their salaries last month, and those who work under Hamas have not received their salaries for the past three months. The situation for this [latter] group is very bad; I know a doctor who phoned a few days ago saying he could not afford the journey to the hospital. For those who live in Rafah or Khan Younis, the journey costs three to four dollars per day. One would rather buy food for his family. This doctor really wanted to come though, so the hospital paid for his journey that day. Everyone is working.”
Though Dad looked quite happy recounting the dedication of his colleagues, I had to move on to a not-very-happy question. I asked him to describe the casualties he has thus far seen.
“Not all wars are the same,” he said. “Incursions in the past were not as bad. This time, most of the injuries fall into one of two categories: first, there are injuries which are the direct result of missiles; these are often very severe, body parts ripped apart. The other category consists of injuries which result from rubble falling down on people: broken ribs and so forth. They [the Israeli army] bombard houses, so there are those who have their walls collapse over their bodies [long silence] and so on.”
I asked him whether there are many women and children in the hospital.
“Yes, a lot,” he said. “I mean, many women, but many more children. They [the Israelis] are probably blind.”
What about amputations?
“A lot. I am sure you’ve seen the pictures. There are so many children whose limbs we had to amputate. There’s a child who came with his belly ripped and legs already gone.”
Dad’s account made me think about images that were broadcast on TV during operations Cast Lead and Pillar of Defense in November 2012 showing individuals, young and old, lying on the floor in the hospitals due to a lack of beds.
“Few people are on the floor,” Dad explained. “When a large number of causalities arrive, we lay some on the floor while we release or transfer low-risk patients to smaller hospitals. This [releasing and transferring] requires one or two hours. This way we can accommodate more people. Thus far, we have been able to cope with the numbers. But the [Shifa] hospital is not equipped to accommodate an increasing number [of causalities].”
So, I asked, if things remain as they are in the next few days, you will not be able to accommodate the numbers?
“Yes, if the offensive continues, we will not be able to accommodate the numbers.”
Dad cleared his throat and added: “In past wars, the border crossing [with Egypt] was opened and they [the Egyptians] allowed many causalities to be transferred to Egypt. This time, only ten were allowed.”
“However,” Dad insisted, “the situation is still under control. We are not yet exhausted in terms of [human] energy and equipment.”
Supplies running out
Though under control, hospitals in Gaza are running out of medical supplies. Dad explains:
“What we are really running out of is sutures, antiseptics, gauze, antibiotics, basically supplies we exhaust in surgeries, supplies that cannot be reused. As for other supplies, I do not have a clear idea; it’s the business of the Ministry [of Health].”
I asked Dad how he and his colleagues are dealing with this shortage.
“We have not hit level zero yet. Besides, all scheduled surgeries from before [the offensive] are on hold; these surgeries can be postponed so we do not waste what we have there. What I can say, however, is that there will be a shortage [in the supplies we have now] even for emergency cases if this offensive continues.”
“In the past [Cast Lead and Pillar of Defense],” Dad complained, “delegations used to visit Gaza all the time. They brought all we needed and there was no shortage. Today, no one is allowed to come. I do not know what on Earth Egypt is thinking.”
My father’s account reminded me of the diaries of Youssif al-Iraki, a Palestinian doctor who survived the 1976 massacre at the Tel al-Zaatar Palestinian refugee camp in Lebanon, which was perpetrated by the Lebanese Phalanges party, or “fascists” as al-Iraki puts it. Tel al-Zaatar was under siege for seven months, during which the population ran out of water, food and medical supplies.
The Red Cross was banned from entering the camp for most of the period of the siege. Even when they entered, they were not allowed to carry with them any supplies. Al-Iraki, however, describes an amazing sense of solidarity among doctors and volunteers in makeshift hospitals in the camp.
Today, Egypt’s policy does not seem to be very different from that of the Phalanges, only that the Egyptian army is relieved of the burden of orchestrating the bloodshed themselves.