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Gaza: “You need to be flexible, improvise… what you have is enough”

09 Nov 2018

Australian nurse Freya Hogarth shares her experience working for Médecins Sans Frontières (MSF), including on assignment earlier this year in Gaza, Palestine.

Freya Hogarth (right) with MSF colleagues in Gaza, Palestine. © Laurie Bonnaud / MSF

What led you to work with MSF?

strongly believe there should be equity in healthcare for all people. I was fortunate enough to receive an education that has placed me in the position to help others, especially in countries where the basic human right to healthcare is not being met. The health needs in these countries are often already extensive, and further exacerbated by conflict, epidemics, or disasters. MSF’s ability to act independently in times of emergency, when a country’s health system is overwhelmed, is what drew me to apply. 

“When the room would shake from airstrikes and my heart would race, my Palestinian colleagues would continue going about their daily work and tell me, “Relax, this is normal, you’re in Gaza”

You’ve recently returned from an assignment in Gaza, Palestine. What did the project and your role there involve?

MSF has been providing medical and psychological assistance to Palestinians in Gaza since 2000. In Gaza Strip, we are running clinics to treat burns and trauma patients, including patients with gunshot injuries who have attended protests at the separation fence with Israel.  Our cohort of burn patients are mostly children who have suffered domestic accidents due to the poor living conditions in the Strip. We also work in the local hospitals, providing specialised surgical support to Palestinian staff.

I went to Gaza in the role of Nursing Activity Manager, as part of MSF’s emergency response to escalating violence at the separation fence between Palestine and Israel during the ‘March of Return’ protests. Our clinics tripled their trauma consultations during this time. Most of the cases were complex gunshot wounds to the lower limbs that required specialised nursing care and dressings. In response, we increased the capacity of two existing clinics in Gaza and opened two additional ones. I spent the majority of my time in the clinics, providing technical support and training new nurses to meet the demand. On the day of the protests I also provided support in the Emergency Department of the local Ministry of Health hospital which was receiving injured people from the separation fence. 

Freya Hogarth with colleagues in Bangladesh. © Freya Hogarth / MSF

What stood out for you in this assignment?

In each of my assignments, the national staff have left a lasting impression on me. The team in Gaza consisted of some of the most resilient and hardworking people I’ve had the privilege of working with. For the Palestinian staff, Gaza is their homeland – but it is also an open-air jail. The 10-year blockade imposed by Israel has meant most have never left the 41 kilometre long enclave. They have been denied adequate food, medicine and education, and have experienced two to three wars during their lifetime. Their ability to remain positive and driven through years of suppression is remarkable. When the room would shake from airstrikes and my heart would race, they would continue going about their daily work and tell me, “Relax, this is normal, you’re in Gaza”.


What do you find most challenging about this type of work?

In Australia we have the privilege of easy access to diagnostic tests, resources, and treatments, which is only dreamt about in MSF projects. The worst cases are when I know the patient would have survived if they were brought into the hospital I work in back home. Witnessing this loss of life that is so preventable – lives that have no lesser value than our own – is unacceptable and devastating every time over.

“Witnessing this loss of life that is so preventable – lives that have no lesser value than our own – is unacceptable and devastating every time over.”

How have you drawn on experience from previous jobs and assignments to develop your nursing skills?

Nursing in remote Indigenous communities in Australia introduced me to working in low resource settings with disadvantaged populations, where you are isolated from loved ones and outside your comfort zone. This experience enabled me to build independence in my own practice, which is essential for a nurse with MSF.

My first assignment in South Sudan was by far the most challenging, factoring in the massive health needs of the population, difficult working and living conditions during the wet season, low resources and the low accessibility of education for the South Sudanese staff. It taught me how to be resilient, and to always take the positive stance no matter how mentally exhausted you may be.    

Freya Hogarth (middle) with colleagues in Palestine. © Freya Hogarth / MSF

What advice would you give to other nurses considering working with MSF?

Set realistic expectations of the context you are entering. Although you can prepare professionally, I’ve seen brilliant nurses break when they cannot practise the type of medicine they are accustomed to with the limited resources they have available on assignment. You need to be flexible, improvise, and accept that this is reality – and that what you have is enough. Having a positive outlook is essential; as is taking the time to invest in building strong relations with your team of national staff, as often they are your most valuable support.