Report from the medical front lines in Gaza

My 5-member Italian plastic surgery team wrapped up their final two operations on Thursday afternoon two hours behind schedule, which was not too bad, considering we were working 15 hour days on average for a week. By our third night in the Gaza Strip, the nocturnal shooting and explosions from the nearby Israeli settlement of Dugit and the Khan Younis refugee camp no longer woke us up. A controlled exhaustion had taken over and even the war outside was merely an occasional distraction.

The team of two surgeons, led by Dr. Enrico Robotti, two nurses and an anesthesiologist from Bergamo near Milan managed, incredibly, 52 complex operations at the new modern European Hospital. The EH, which is southeast of Khan Younis on what is now the main and only road to Rafah and the Egyptian border, is lacking only specialists like plastic surgeons.

This was the first plastic surgery team ever in southern Gaza and judging by the huge number of patients desperate for help at the two open screening days, we only managed a small dent in the waiting list.

By Thursday morning, the general situation in the Gaza Strip was deteriorating by the hour. During our working week, two Palestinian youths were caught in a tunnel between Rafah and Egypt and murdered, the Palestinians then managed to blow up an IDF tank near Beit Lahya in the north, killing four soldiers. A day later, the Israelis booby-trapped a drone, which exploded and killed six suspected Islamic militants in Gaza city.

On Monday night, the IDF invaded Gaza City, killing 11 people, including a family crushed by bulldozers in their home. The Palestinians then responded by firing home-made rockets into the Negev town of Sederot, injuring an Israeli worker. Each day brought worse news to Gaza, with the tension peaking just as we were to make our way north out of Khan Younis to Gaza City.

Tanks were on the border, hospital employees were saying, and any day they would roll into Khan Younis for another pound of Palestinian flesh. I tried not to alarm the team to what was going on outside of the OR, as they were pretty isolated working all day in surgery, but sometimes the reality of Israeli occupation and Palestinian resistance came to them.

On Sunday, a 12-year-old boy from Rafah was brought in to the OR after being shot through both legs by an IDF sniper. The Italian nurses looked on as local surgeons did their best to repair the bone, nerve and vascular damage. “He was standing near a neighbor’s home that was destroyed by tanks the night before,” his nervous father told me outside the OR. “There were no clashes or anything going on. It was an unprovoked shooting.”

On Thursday morning I anxiously called the US Embassy to try to get permission for my team by to cross the two IDF checkpoints that had been closed in the morning. Gaza was now cut into three sections, and we were stuck at the bottom. I had the unenviable task of trying to get five volunteer international medical personnel past both the “Abu Houl” permanent IDF checkpoint, as well as the temporary Netzarim roadblock set up on the coastal road where the Israeli settlement of the same name sits in the middle of Gaza.

The Italians needed to get out to Jerusalem on Friday morning, which is why I needed to get them to Gaza City on Thursday night. Staying overnight in Khan Younis would make getting out of Gaza on Friday nearly impossible.

After a brief ceremonial dinner of appreciation with the local medical team, I put the three Italian ladies into a the clearly marked ambulance with our luggage, while Enrico and the other surgeon, Dr. Luca, followed in my red Audi with international plates. We headed north through the nearly deserted streets of Khan Younis at dusk towards the first checkpoint.

Abdullah Abu Salah

My contact at the American embassy had called and said that while we had permission to pass through the IDF checkpoints, there were cars backed up and we should not wait in line but to just try to pass around them. A long row of idle cars greeted us when we reached the “Abu Houl” checkpoint, which cuts Gaza in half and is managed by two IDF firebases a half mile apart. These firebases are windowless cement tower with only slits for machine guns where soldiers direct cars by a remote traffic signal and a loudspeaker.

Settler cars pass freely over the gutted Palestinian road on a new bridge, protected from Palestinian snipers by cement barriers, barbed wire and tanks. As we started to pass around the jammed traffic, I saw three young ItaliansI had met a few days earlier at the hospital. They had brought me two crippled children who needed wheelchairs, as their parents had been carrying them around for years and were too poor to afford them any material relief. I had just sent a container of wheelchairs to Gaza in January, so I directed these young Italians to Suheil, my project manager in Gaza, to get the children the chairs they needed. The agreement was that the family should then send the children to school.

The three young Italians were standing at the bottom edge of a large group just south of the Israeli firebase, which was enforcing the closure and cutting off the southern Gaza Strip and its nearly 400,000 residents from the north and central areas. The Italians were in Gaza as part of a growing international solidarity movement in Palestine of mainly brave young men and women from Europe and the US who try to serve as a form of protection for the occupied population, though usually they are little more than witnesses to shootings and home demolitions that occur here on a dialy basis. They risk being shot and beaten by soldiers and Israeli settlers, and are often stopped at the Tel Aviv airport, and put back on the next plane back to where they came from once they are identified as solidarity activists.

“We tried to talk to the soldiers an hour ago to get them to allow a sick woman to pass through, but they refused,” a bearded blond Giancarlo told me after a handshake. “We sent Francesca, a woman, to approach their tank, which just left, and they told her that they had orders not to let anyone pass. She told them there was a sick woman who needed to go to Shifa Hospital in Gaza, but they said no. I don’t think you will get through.” I walked with him to the front of the crowd and told him I’d prearranged permission to pass through my embassy. “Just be careful when you approach them. We sent Francesa because she is a women. We thought it was less threatening to them and they wouldn’t shoot. They’re very nervous.”

An unofficial border had been established about 50 meters from the firebase, which had two huge spotlights on top facing the crowd. They were so bright you were almost blinded when looking towards the Israeli side. It illuminated the crowd perfectly, once I was in front, and I saw clearly the various expressions of anger, boredom, desperation and pity on the scores of young and old mainly students and workers who had been waiting nearly 12 hours to pass north since the checkpoint was closed n the morning.. As usual, kids in their early teens or younger were at the front of the cars venting their youthful energy by aggressively pushing and playing with each other, taunting the Israeli soldiers with insults, and in turn bothering the foreigners with stupid jokes, questions and veiled abuse.

One teenager, whose head was wrapped tightly in a red Keffiyah for protection from the cold, stood a foot away starting at me for several minutes as I discussed out options of getting past with the ambulance driver. I could feel his glare and turned to him to say hello. “Where are you going?” he asked me, not yet sure if I was a friend or enemy. After telling him we were going to Gaza, he said he had been standing there for 12 hours. I had no intention of being stuck like that, so I held up my passport and walked slowly towards the two bright lights one the firebase calling out “hello” in clear English as I went. The crowd stayed behind watching as I slowly went about 10 meters past a puddle of mud.

A soldier told me in broken Arabic through a static loudspeaker to go back to my car and approach with the ambulance slowly. We cautiously crossed over near the front of the firebase just as an IDF jeep pulled up to block our path. Three soldiers got out and told me to stop and turn off my lights as they inspected the ambulance. The three Italian ladies were ordered out while soldiers checked their passports and our luggage. They then told me to approach and turn off my car.

Luca, Enrico and I got out as the three soldiers nersouly eyed the crowd behind us. There were no smiles or small talk between us. They checked my trunk and made me open my briefcase. I asked the officer if there was another checkpoint before Gaza City and he told me there was on the coastal road, but that he would call ahead and let them know that we are coming. “They are so young,” Enrico said as we slowly pulled away from the checkpoint for the half-mile trip to the other side of “Abu Houl,” where we soon found about the he same number of stuck Palestinians waiting in or by their cars to cross over to southern Gaza.

Another IDF firebase with two huge spotlights guarded the northern entrance of the settler’s road, preventing any Palestinian car from passing with the same remote traffic light, loudspeaker and mounted machine gun through the slit in the window. Once we reached the Palestinian side we were almost immediately trapped behind an empty semi truck facing the same direction that we were. The situation on this side of the crossing was much worse, as the Palestinians had jammed the entire road with cars and the Israelis had put up cement or earthen barriers on each side of the road to prevent any cars from going around where we were at. In front of us was the semi facing Gaza City, while yellow shared taxis full of passengers faced Khan Younis. Enrico, Luca and I at once realized we were seriously stuck and that they only open road out of this mess would free us. No permission from any embassy was going to help the chaos of people stuck for 12 hours at a roadblock in the middle of a war.

As I got out of my car to check out the extent of the jam, a voice called out from the back of a Mercedes 8-seat taxi. “Do you have water?” a man asked in perfect English. “I have a baby inside and we have been here 12 hours. We don’t have food or water.” I went to the trunk and got a large bottle of water and a bag of pretzels that I had brought from the guest house at the European Hospital from my bag. I saw a small baby no older than a year in the back with the man’s wife as I handed him the water. “We need diapers and a blanket. Do you have that also? He asked.” I didn’t.

Enrico and I discussed with the ladies our options of getting out of this mess Gaza as Luca slept in the back seat of my Audi. “Let’s go see how bad this really is,” Enrico said as he lit up a cigar. I was deeply grateful that none of the Italian team, for the entire week of work and up to our current predicament, had not expressed a single worrisome comment or complaint. Much of that was due to Enrio’s leadership. He never said no to anyone or anything, and this rubbed off on his team. Their positive attitude made my job of taking care of them much easier. We walked in the dark past various groups of men past the semi blocking our way and stood for a while on a pile of dirt set up by Israeli bulldozers to block traffic from using a nearby field to go around the road.

In front of the truck were three or four more vans blocking our way forward. “If we could get past them, we could get back on the road towards Gaza,” Enrco said. There was no chance of getting any of these cars to move, as there was seemingly no place for them to go. There was barley enough room to walk between the cars, let along getting them to make space for us. As we stood in the clear mild evening taking in our bad luck, a group of youths built a small fire and began signing and clapping their hands. The crowd grew and a different guy would add a humorous verse, getting laughs and catcalls. “You can’t break their spirit,” Enrico said as we walked back towards the ambulance. “I want to go!” shouted a youth at no one in particular as the song broke up.

Enrico and I agreed that I would try to talk to the soldier in the firebase to see if he would let us back up and use the settler’s road to get out. It was a long shot, but our other options at that point were pretty limited. I walked up to the edge of the line where youths hid behind cement barriers for protection as they occasionally called out insults in Hebrew and Arabic. Another group stood behind me as I walked slowly towards the two lights and tower yelling out “Shalom” as loud as I could to whoever was inside. I hoped it was a leftist.

Caution got the better of me after about 10 meters, as I figured he could hear me. This was the same firebase that last September I had spoke at length to a young Israeli soldier after being stopped at the checkpoint with two young American doctors on our way to Khan Younis. It was daylight then and the general situation in Gaza was nowhere near as tense as it was on this night. Tonight the situation was much different. After each “Shalom” that I shouted into the blinding lights, the youths hiding behind the barriers next would add “eat shit” and other insults, not helping my cause the least. After about six calls on my part, a response finally came. “Go from here,” was the response in Arabic. “I don’t speak Arabic, we’re foreigners,” I responded with some shame, having to resort to the “foreigner” card while the rest of the locals had nothing to fall back on, despite the fact that it was their own country. “We’re stuck and I would like to ask your help,” I yelled, opening my passport, which I held up over my head. The sharp crack of an M-16 was his response, followed by another. My visa, which was on a separate piece of paper, fluttered out of my passport into a ditch nearby. I walked backward to Enrico. “I guess that’s the end of that idea,” I said. “These guys kept moving up behind you,” Enrico said. “If they would have stayed still, maybe he would not have shot.”

We went back to the ambulance, where two of the girls were getting anxious, not from the bad situation but from the lack of toilet facilities. Flares were fired into the clear dark sky over a nearby settlement to the south as I eyed a palm tree as an option to relieve the ladies. More and more people crowded around the ambulance, some trying to sell us tea or coffee, while others just wanting to talk. “You see how they treat us,” an older man said in good English. “Like animals, worse than animals. My brother has a goat and he is treated better than the Israelis treat us.” Another man picked up the same tone. “There are small children here. What do we feed them? Where will they sleep?” As I pondered a response that would both provide sympathy and understanding, another ambulance pulled up behind my car from the other side where we had come an hour before. The driver blew his siren and horn, which was met with a combination of concern and humor by the crowd. “Good luck, to him” I said, while Enrico realized this might be our lucky break. “It is like an angel sent this miracle for us,” he said half seriously as people slowly started to try to figure out a way to get the ambulance through the jam.

Unlike our ambulance, which was carrying only doctors and nurses, people took notice of what was soon discovered to be a sick woman, perhaps the same one the young Italians on the other side had trued to help hours ago to cross.

While a new energy came over the crowd, I called Khaled, my fieldworker in the central district, and asked him if we could crash at his house if we couldn’t get out of the jam. I couldn’t let my team sleep at a checkpoint in Gaza after working 16 hour days for a week as volunteers, even if it meant abandoning my car. Khaled asked where I was and said he’d come meet us just as there started to be some movement among cars to my left.

A crowd had organized a way to get the ambulance past the jam, and within minutes, a path for our ambulance, my car, and the ambulance behind me was created. Our ambulance went first down the small mound and immediately got stuck in mud. A group of men ran up and managed to free it after a few minutes of rocking it back and forth. I allowed a car to move make space for me to take a drier route, falling in behind our ambulance without getting dealing with mud. We were soon slowly moving forward past the trucks, car and taxis that had held us prisoner for over an hour. They had been sitting for 12 hours, and faced the likely prospect of spending the cold night at the checkpoint. Khaled, jumped in my car just as we headed towards the town and adjacent refugee camp of Deir El Balah. I told Khaled we would try to get to Gaza City past Netzarim, but if we failed, we would need to stay with him. He said no problem and jumped out of the car as I slowed down. I wanted to keep pace with the first ambulance, which had since passed us. It was our best bet in getting past the road block a few miles up ahead.

The coastal road between Dier El Balah and Gaza, for the first time that I could remember, was completely empty of cars. With the sea on our left, sand on our right and the red flashing lights illuminating the dark night in front, we soon reached the Palestinian side of the Netzarim roadblock, which was set up at the long-since closed Haifa Resturant. Only three years ago, before the Intifada, I hosted a dinner there with a team of doctors from the States. Now two Palestinian soldiers stood with old AK-47s and walkie talkies. Unlike the other checkpoint, only a few cars stood on the side of the road and a half dozen people milled around. There were no signs ahead of the IDF, which was not a good indication for us. If we could not see them, how can we talk to them to be sure we can pass? The Palestinian soldier spoke to the first ambulance driver and waved him forward into the dark night. I thought it was some kind of coordination with the IDF, but later realized he was saying, if you want to go then go. It’s not on my advice. We followed slowly behind the first ambulance with the sick woman, not knowing for sure what would happen. Even with help from the US embassy and the other IDF officer calling ahead, rules change in Gaza when the sun goes down. As we drove about 50 meters up to a sand dune, a shot rang out and the first ambulance stopped. Another sharp crack was followed by a red streak bouncing on the road right in front of the ambulance with the Italian women. We stopped moving and the first two ambulances turned around as another shot rang out. I put my car in reverse and drove backwards back to the Palestinian soldiers.

We regrouped at the Haifa Resturant and I went to see if the girl’s ambulance had been hit. I thought I heard the sound of an impact after the third shot, but thankfully didn’t find any bullet holes. The other driver was angry at us for following him, as if that had anything to do with the soldiers shooting “Do you believe they shot at an ambulance?” I asked Angelica, the Anesthsiologist. “What country in the world shoots at ambulances?” Though they were probably warning shots, I had seen several Palestinian ambulances with bullet holes in them, and remember the head of the emergency services was killed last March when an Israeli soldier shot a rifle grenade into his ambulance as they tried to rescue an injured girl in the Jenin camp. This was two months before the battle in the refugee camp. It is an unfortunate fact that the IDF does not respect the neutrality of ambulances or emergency medical personnel in the territories.

We watched a half hour later as the first ambulance again tried to cross Netzarim, this time by itself, again turning back after shots were fired at it. After standing for another half hour trying to coordinate by phone permission through a Palestinian lesion, we agreed to call Khaled and to go crash at his house in the Maghazi refugee camp. It was nearly 10 PM, 5 hours since we left the European Hospital.

Despite it being in an impoverished Gaza refugee camp, Khaled’s family had worked hard to build a comfortable home. In addition to being my fieldworker for the four refugee camps in his district, Khaled worked nights as a nurse at Shifa Hospital. His brothers and their wives warmly welcomed us and set up places for us to sleep in two rooms on the floor. Unlike the nights during the past week at, there was no gunfire disturbing, only the call to prayer. Everyone agreed the next morning that it was the most comfortable sleep we had during the whole week.

We started back at 9 AM hoping that daylight would change our luck at passing Netzarim. I called the US Embassy on our way back up the coastal road and was told that they would call the Israelis to see what the prospects were for us getting through. When we got to Netzarim, there were already a few cars waiting to cross up ahead, though there was still no sign of any kind of checkpoint or anyone moving. “There is a tank in the road,” said our ambulance driver, though I couldn’t see it. “That’s their checkpoint.” The ambulance who had tried to cross last night with the sick woman was leaving back towards Khan Younis when we arrived. They had been there all night. Down on the beach, horses and donkeys pulled carts of people and produce around the roadblock. The IDF was not preventing people from using the beach to circumvent Netzarim, though the road remained closed. The embassy called and said that they heard the checkpoint would open at 10 AM, though that was not for certain. We walked down to the sea on a clear but cool Friday morning to wait for a half hour, until 10 AM, to see if the checkpoint would indeed open and we could pass.

A donkey cart loaded to the hilt with zucchini cautiously made its way down from the road to the beach, while workers and unarmed Palestinian soldiers walked down the beach from the north. A truck full of chickens drove through the surf heading north. How they got down to the beach, and how they planned to get back up to the road, was unclear. I thought this might be an option for us, but Enrico advised me not to try it with my Audi. With my luck, it’d be washing up on the Italian shore six months from now.

10 AM came and went with no clear indication that the checkpoint would open. I hated leaving my car in Gaza, but it was clear that I had no choice. Despite the occasional burst of far off machine fire, we loaded all of our bags on a donkey cart and went back down to the beach to walk north around the Netzarim roadblock and the Israeli tank blocking the raod. Four wheelers cruised past in the surf as our bags went far ahead on the donkey cart. We passed tired mothers carrying small children, some also carrying bags of food or supplies. “Take pictures of this,” a man said to me in an angry voice. About a mile later we came up on the other side of the coastal road, where the Ministry of Health driver Saad were waiting with a van. We loaded in our luggage and I paid the donkey driver thirty shekels, or about $6.50 to taking out bags around. . As we headed out towards Gaza City, Saad told the Italians not to take photos, as there was an IDF tank on the road. The sound of nearby gunfire was coming from the Israeli side as we turned north. I could hear the sharp crack and thud of several bullets fired seconds apart, though where they were hitting was not clear. I leaned away from the window.

“You know what happened to my family?” Saad asked me in a somber voice once we were clear of tank. “My nephew was killed outside his home.” I knew his brother was killed last year in an air raid and that Saad was working to support both his family and that of his martyred brother’s. “When did that happen?” I asked. “This morning. He was assassinated outside his home. He was 19 years old.”

We changed vans again at the guest house and headed towards the Erez crossing, which would end our journey from Khan Younis finally. I worried that my lost visa might cause us delays, and contemplated different stories for the solider in case they made a big deal about it. I decided to tell the truth, that I was shot at, dropped it, and lacked the courage to bend over and pick it up, lest the soldier think I was reaching for a stone or something.

Fortunately, the soldier on duty was one I had met many times. During the elections he revealed that he was voting for Mitzna and the Labor party and wanted some kind of peace with the Palestinians. I simply told him I lost my visa and he smiled and gave me a gate pass to get out of Erez and on to Jerusalem in our taxi, no questions asked. As I bid farewell to the Italian team later in Jerusalem, I was really impressed by how well they all held up under the stress and difficulties that we faced over the previous 24 hours, as well as the entire week. I never once heard them complain, express fear or regret in coming to provide treatment for burned and injured children, and for that I thanked them over and over again. I really admire and respect them for not only their humanity, which is sorely lacking here these days, but also their courage. This is something, I suspect, that we all learned from the Palestinians themselves.

Steve Sosebee is President and CEO of The Palestine Children’s Relief Fund.