When Dr. Hussein Shomar graduated with a medical degree from Al-Azhar University in 2008, he had no plans to practice medicine anywhere but Gaza. In fact, he had become a doctor to help alleviate what he saw as the suffering of Palestinians living in Gaza.
Yet, in 2015, after years of work as a surgeon at al-Shifa hospital, he decided he had to leave Gaza.
“If there was no blockade, no need for referrals and no occupation, I would not have contemplated leaving,” he said.
He had once aspired to be “a doctor who could prescribe medications without concerns about their availability,” a doctor who could “provide comprehensive patient care.”
But he found that this was not possible in Gaza due to the Israeli blockade, which has caused a shortage of medications and medical devices.
He felt severely constricted on a day-to-day basis in his ability to treat his patients.
Dr. Shomar found himself prescribing whatever medications were available, even if they were not the most effective.
Most often, he would have to refer his patients for treatment outside of Gaza.
Shomar, 39, is now a consultant surgeon in the western German city of Bitburg, where he has experienced professional growth that seemed unattainable in Gaza.
In moving abroad, he is not alone. Doctors are leaving Gaza in search of better working conditions and professional development.
Deadly cycle of referral
Dr. Muhammad Zughbur, a dean at the College of Medicine at Al-Azhar University in Gaza, acknowledged an increased rate of doctor migration abroad.
“Doctor retention is not just about the desperate need for medical care, particularly during the many Israeli onslaughts, it is also about national security,” he said in an interview with The Electronic Intifada.
“This was clear during the COVID-19 pandemic, when the international demand for health providers was at its highest,” he continued. “Countries’ health security relied mainly on doctors, and Gaza was no exception.”
As doctors leave Gaza, it further fuels the cycle of referring patients to doctors outside of Gaza. This cycle can be perilous for Palestinians, since travel permits, even for urgent medical care, are routinely denied by Israel.
Impact of May 2021
Dr. Hanin Hammouda obtained her medical degree from Gaza’s Al-Azhar University in 2019.
Not long after she graduated, she went to work at al-Shifa hospital, where she was shocked by its dire situation – a situation only amplified by the onset of the COVID-19 pandemic in 2020.
The hospital, already understaffed and equipped with meager resources to treat patients, was overwhelmed by the pandemic. Then, Israel launched an 11-day assault on the Gaza Strip, damaging or destroying 19 medical facilities as well as the road to al-Shifa hospital, the “only hospital in Gaza equipped for emergency assistance.”
May 2021 was a hellish time for most in Gaza, and especially those working at al-Shifa hospital.
Dr. Hammouda saw an influx of patients with horrific injuries: burned flesh, shattered jaws, severe eye damage. At hospitals in Gaza, the war “did not end with a truce call. The activity in hospitals continued unabated for a long time afterward,” she said.
She worked to the brink of exhaustion and was filled with nonstop worry about her husband and child at home.
“The anxiety ate at me,” she said, “and the immense workload during such periods proved to be overwhelming.”
Dr. Hammouda lost her dear clinical teacher, Dr. Ayman Abu al-Ouf, during the war. He was killed, along with his wife, two children and other immediate family members, during an Israeli attack on his home after he had returned from work.
Safety and security were nowhere to be found.
Such losses, and the desire for a more stable existence, pushed Dr. Hammouda to move in February 2022 to Germany, where she now specializes in internal medicine.
Lift the blockade
A.J., a doctor who preferred to remain anonymous, returned to Gaza in 2019 after obtaining a medical degree in Cuba.
During his internship year in 2020, he was shocked by the level of dysfunction in Gaza’s healthcare system, which was far worse than he expected.
“The system is a chaotic mess,” he said. Hospitals are understaffed and the doctors are overworked for little pay.
“On top of that, the reward is abuse and mistrust,” he said, describing situations where many patients in Gaza do not trust doctors due to their own understandable frustrations with the healthcare system.
A.J.’s family wanted him to remain in Gaza, but he decided to move to Spain, where he now works as an ER doctor, in pursuit of a better life.
“I would not be able to learn anything [in Gaza],” he said. “I did not leave just to leave. Everything compelled me to leave. The suffocating occupation made me leave. I wanted to help myself and my family.”
Dr. Shomar, who worked as a doctor in Gaza during several Israeli wars, agreed about the lack of opportunities to learn.
“There was no feedback on our performance during those times [of war],” he said. “We did not get any feedback. We did not know what was wrong and what was right, what was a good job and what we could do better.”
Doctors need “recognition, support and access to resources to unleash our potential,” Dr. Shomar said.
A.J. sees a future for himself in Gaza. “Once the Israeli blockade is lifted and hospitals are adequately equipped, I will return without hesitation,” he said.
Sewar Elejla is a doctor at al-Shifa hospital and a researcher.
Ola Hammouda is an English lecturer and administrative assistant at the University College of Applied Sciences.