Gaza: "The smell of blood is unbearable"

How does the situation in Gaza compare to contexts you've worked in previously with MSF?

I think all conflicts are awful, and it’s always the children and the women that pay the price and that is true in Gaza. I’ve worked with MSF in other conflict zones, in Tigray in Ethiopia and in the Ukraine. The difference that I see in Gaza is that there’s so many displaced people in one small area. The amount of people crammed into this tiny area with makeshift tents, with overcrowding, poor ventilation, no access to clean drinking water, no effective sanitation facilities, and really high food insecurity is just mind boggling. The amount of people, I can’t stress enough seeing the amount of people in one small space, in tents made of blankets and old bits of plastic. In Al Aqsa hospital, where I’m working, the displaced people have made themselves tents within the hospital, with used IV lines and blankets draped over these, to make themselves a little private area amongst the crush of humanity.  

Basically, people being herded into very small areas that make them such a big target for the constant air strikes and shelling, when there’s so many together, you’re going to get so much collateral damage as we saw in Nuseirat on 8 June. 

Can you describe the conditions you’re working under? What are the common injuries you are seeing?

My main activities are around the Al Aqsa hospital, in the emergency and in particular the ‘red zone,’ which is like our resus rooms in Australia. Our resus area is the size of my resus area in Broome hospital ED, which is not very big. At times we’ve had up to 8 or more critical patients in there, on the floor, because there’s not enough room for beds. There are only two ventilators in the ‘red zone’ there and two monitors, but only 1 BP (blood pressure) cuff works, so you have to move the BP cuff between all your patients, and there’s only two SATS probes (measures oxygen). They are very hard conditions.

The staff working there are sensational. I don’t know how they keep showing up. They work 24 hour shifts there and they have 2 days off. So, they’re working 24 hours, mass casualties every day, most days. Then they go home to sleep in a tent, with all of the awfulness that comes with living in a tent in a beach location, in that there’s sandflies, there’s no toilets, there’s no shower facilities. These are professionals that show up everyday day in their scrubs, and then work in this environment, when they don’t have enough equipment. And still do very professional jobs, I’m in awe of them.  

When we talk about medical equipment and access to medical supplies, the Rafah crossing has been closed now for a month. As of early June we haven’t had any replenishment of medical supplies, and we don’t know when we’ll get anymore. To deny people access to basic medical equipment like gauze and gloves, things that are needed, it’s unspeakable, it’s very sinister to stop this. 

The most common injuries that we are seeing are blast injuries, so mainly broken legs, chest injuries, and shrapnel injuries as well as burns, these are the most common things we’re seeing. People are rescuing them from the rubble and bringing them straight into the hospital, and they are covered in dust and ash and blood, and then they put on the floor of Al Aqsa hospital, where the staff look after them, often in the blood of the people who’ve just left. I myself have never seen anything like it. 

On the weekend of 8-9 June we had a really big mass casualty event, which is probably the equivalent of, if a jumbo jet crashed in Broome how would the hospital respond. It’s a very similar number of staff, similar size ED, but less resources here, than in Broome hospital. We had hundreds of casualties present, and I believe it was over 150 deaths that occurred. No hospital on this planet can cope with that amount of people, but from what I saw, all the staff were amazing, they went above and beyond. Things like the cleaners going in between patients and cleaning, so that we can put another patient there. There was a little boy going around giving all the health workers cold water because it was very very hot. 

The air conditioner doesn’t work, they have one generator, the second generator broke, and the solar system has broken, as well so we’re working on one generator. The fuel here is very, very hard to get.  The UN has a cap on how much it can bring in every week, it has to provide all the hospitals and ambulances and vehicles and this sort of thing, so often in Al Aqsa hospital we have blackouts. I know of one case last week of a woman on a ventilator who died because there was just too many critical patients, the black out happened and no one ‘bagged’ her, and she died, which is terribly sad—all for a lack of resources and simple things that we take for granted, like power.  

There is a shortage of medication, there is shortage of analgesia especially, a shortage of paralysing agents and such things you need for intubation. Mostly we use ketamine for pretty much everything, it seems we have a supply of this, how long that supply will last who knows? Not knowing when the borders will open, there’s no possible way we can know how long our supplies will last. 

The most traumatic injuries for me are the children. They come in, unaccompanied, who knows where their families are. Their little bodies are just destroyed by shrapnel, and I think this is …. this is something that will stay with me for ever. I don’t even know how to convey this to Australians at home—that we need to start caring about this, these are children. I look at them and I see my nephews, they’re the same age. They are running around, trying to have fun and do all the things that kids do amongst rubble, in a dangerous environment and then, they are just ripped apart.

In the face of so many injured people, how do you decide who to help? 

We follow the same protocol as we would in Australia. There’s red patients, yellow patients, and green patients. Green patients are your walk-in wounded, yellow patients need a little more attention, and red patients are critical. Then you have your black patients, and they are dead or dying.

So often we have to say: ‘we can’t fix this person, we have limited resources and there’s just too many, and this one today we cannot help.’ That is very, very difficult, and you think about it often, about the ones that have gone to the black zone. All we’re trying to do is save as many as we can, under extreme duress.

During the incident in Nuseirat, we were told to evacuate, as there was the possibility there was going to be a strike at the hospital—but the staff stayed. That is incredible courage, fortitude, and professionalism. To look after so many people coming in while still being so frightened and aware that at any moment that something could fall from the sky and take them out. 

How are you coping physically and emotionally with what you are seeing? 

Short answer: I’m tired, I’m so tired. Every night we don’t sleep for very long, maybe two hours at a stretch, because of air strikes and shelling. The drones are relentless and people have been living like this for eight months, on little sleep, interrupted sleep. It does affect your physical health; I look haggard at the minute.
It’s just the relentless bombardment of your senses by this advanced military hardware, and it doesn’t seem like a fair fight when you’re living in a tent, to have drones humming over you, keeping you up all night when you have to work and provide for your family the next day.  So, I’d say my health is better than most people living here at the moment. 

Emotionally, it’s very upsetting. It’s a very complicated political situation, I don’t have a view one way or the other really on that but I think if you are killing children and women, who have no part in any of this political playground of men, that’s not right. That needs attention. 

To see the trauma of these injuries, is just unbelievable, and the number of them is mind boggling. I don’t know how I’ll be after this, I’m lucky I’ve got very good friends and an excellent husband who’ve been able to talk to during this time, to keep me grounded. But it is extremely upsetting to see this, and also very humbling to witness the courage of the people here. 

Are you scared for your safety?

I am at times scared for own safety. Nowhere in Gaza is safe. Areas in the so called ‘safe zone’ have been hit numerous times. There’s no safe area in Gaza at all. We are in the green zone and the other day there was a strikes 100 metres from the office, and when it strikes it takes the wind out of you, the breath out of you, it’s a very intense vibration. Even when we lie in bed at night and we can hear the airstrikes, they’re not danger close, they are there within a few kilometres—but those times you’re not worried for you safety; you know every time that hits the ground someone has died or someone is terribly injured, and that’s a terrible thing to know. You have the pictures of previous air strikes and those victims in your head. You know exactly what’s happened at that scene.

I am seeing the absolute worst of humanity and the absolute best of it as well. It has been one of the honours of my life to be here working. The resilience of the people here is astounding. You’d be surprised that there’s many laughs in a day with our local staff. But they are all hurting, they’re hurting so much, and they’re so tired and eight months is long enough, surely?  

I just wish for the Australian people to understand that people here are just like us. They love their air conditioners, they love cool soft drinks, their falafels are outstanding!  These are people just like us and they are really, really suffering.

So, thank you for this opportunity to talk with you.  And I hope to be home soon, Inshallah. 

A version of this story first appeared in WA Today.