Trauma Wards

Last month, The Nation published a conversation between Mary Turfah and Dr. Tanya Haj-Hassan, a pediatric intensivist who works with Médecins Sans Frontières and volunteered in Gaza both before and after October 7, about “the front lines of Gaza’s hospital hell.” She details the destruction of Gaza’s medical system, as well as the widespread abduction, torture, and murder of health care workers. At the time of the article, at least 493 killings of health care workers had been documented, and every single hospital in Gaza had been targeted in one way or another—with some demolished in their entirety and others rendered nonfunctional due to the destruction of equipment and the flight, abduction, or murder of staff. Turfah notes that “the Israeli forces were targeting the doctors with the most years of experience . . . which [leaves behind] . . . the more junior attendings, the residents, the medical students, who are then expected to step up and take on tasks well beyond their training.”

Dr. Ameera Qudieh is one of these junior physicians. She graduated from the medical school at al-Azhar University–Gaza in 2023, shortly before Israel destroyed it. She started volunteering at Nasser Medical Complex at the outset of the conflict, began living in the hospital full time during its siege, and was forced to evacuate in February. Before her initial evacuation, she worked closely with several senior doctors who disappeared into Israeli custody, including Dr. Khaled al-Serr, whose whereabouts remain unknown.

Three months after the evacuation, Ameera returned to volunteering at Nasser. When she is not volunteering, Ameera lives in a refugee camp in al-Mawasi in southern Gaza, near the city of Rafah, that has been designated a “humanitarian zone.” She prefers to feel active and useful through volunteering, as opposed to sitting in the tent waiting for the sound of bombs.

Our interview took place over the course of several weeks. Sometimes we would go days without speaking because of Ameera’s spotty cell and internet access. There were times when her silences corresponded with airstrikes on camps for displaced people in southern Gaza, including one attack on Tal al-Sultan on May 26 that killed dozens of civilians and yielded a video of a man holding up a headless toddler in disbelief while tents burned in the background. When Ameera did not reply, I tried to assume that it was because the internet was down and not that she had been harmed. Our conversation has been edited for length and clarity.

—Tobias Kirchwey

Tobias Kirchwey: Tell me about the siege and evacuation of Nasser in February.

Ameera Qudieh: In those days the hospital was besieged by the Israeli army, and I was in the hospital with the few other remaining medical staff. Many doctors had fled to save their lives. I was living in a hospital room with a friend of mine—her name is Israa Abu Raqaa—who worked as a radiology technician. We ate breakfast, lunch, and dinner together each day. My family was also living inside the hospital at the time, in another room. When we knew we were going to have to evacuate, I asked Israa to come with me and my family, but she said that she preferred to leave with her colleagues from the radiology department, so I told her to stay safe and take care of herself, and we said goodbye.

Israa and her colleagues were targeted by an airstrike as they were leaving, in what was supposed to be a “safe passage,” and she was badly injured. I’ll send you the video—someone shared it on Instagram. If you see it you will cry. She was silent; she was in a lot of pain, but she didn’t talk or cry or scream. She looked calm because she was in shock, not knowing what had happened to her.

She suffered from rocket fragments that destroyed the skin and muscle in her back and buttock. When she went to the IMC field hospital the doctors noticed that her abdomen was rigid. They did an ultrasound and saw free fluid, so they took her to the OR for an exploratory laparotomy. They found she had an injury to her rectum, so they did a colostomy. But soon after the surgery, she started to have pus coming out of the surgical site and she developed a fever. There was no CT scanner, so they did another abdominal exploration surgery. Since then she has had a total of five exploratory laparotomies. [Three months later] she still has a fever and is still draining pus from her abdomen.

She is very dear to me, so I stayed with her in the IMC field hospital, sleeping there and taking care of her. She’s still in the ICU, and she is still conscious and oriented. I imagine myself being there with her when she was injured, and imagine myself being injured like her; I imagine myself crying, seeing her on the ground.

The video begins with a crashing sound. The camera shakes, sideways, the horizon bisects the screen and shudders as the photographer runs. As the camera steadies, you can see him running toward a group of people crouched in the middle of the road behind a stopped car. The road is otherwise empty. By the roadside there are few trees. Clouds pile high in the blue sky. The camera turns to the man carrying it, and then turns back to the car in the middle of the road. The group parts to reveal a young woman lying in a crescent of blood. Her eyes turn up toward the camera, and then turn back down, and she doesn’t say anything. She is holding her hands loosely beside her head. The people around her are screaming and rolling gauze around her lower abdomen, which appears to be the source of the bleeding. The video cuts; now we are in the back of a car, and someone in the car is crying, but it is not the woman who has been injured. She looks at the camera again and winces. There is a second explosion, and out of the window of a car we can see a child startle and run. Ahead of the car we now see traffic and a group of buildings. The driver’s hand does not leave the horn. Then the video ends and loops back to the beginning.

TK: This raises a lot of questions. Are Israa’s injuries typical of what you’ve seen in the past year? Speaking with other health care workers who have been in Gaza, I’ve gotten the impression that there are severe shortages of nearly everything—from specialized medical staff to antibiotics, analgesics, and clean water. How can you recover from injuries like Israa’s in the absence of these things?

AQ: After an airstrike, you see exactly what you would imagine: the destruction of the human body. There is a lot of range. If your patient has been under the rubble for a long time, or if he has burns, you may see large raw areas with loss of muscles and tendons. We also see many cases of traumatic hemothorax [bleeding in the pleural cavity] and pneumothorax [collapsed lung]. If a patient is struggling to breathe or keep their oxygen saturation up and it’s not a hemo- or pneumothorax, it’s probably a lung contusion. Most patients have many different injuries simultaneously, and many have multiple fractures. It all depends on the mechanism of their injury. The most frequent in the case of airstrikes is burns to the body. If there’s severe bleeding from a limb, the limb usually gets amputated. Patients with burns over a large percentage of their body surface area tend to die of dehydration or infection. The nurses and doctors try to help them survive, but a very large number die.

There are also many patients who need specialty care that is lacking in Gaza. They should be evacuated, but as you know, the borders are closed. Even when the borders were open, there was a long line of people waiting to travel for medical care, but they couldn’t because many other countries don’t care about helping us. So many people died, and continue to die, because they couldn’t evacuate.

Israa has had multiple surgeries, and has been on antibiotics for months, but even so, she’s not getting better. The situation in Gaza is this: there’s no clean water, no sterile operating conditions, no access to a clean environment . . . so most patients in her scenario develop sepsis.

Unfortunately, many of the more senior doctors had to get out of Gaza to save their own lives. We don’t have cardiac surgeons anymore, for instance, and we hardly have any neurosurgeons. Most of them have evacuated, and the others were killed in this war or in previous wars. Most of the doctors working here are young, recent graduates. As far as supplies and equipment in the ER are concerned, we don’t have enough paper to write lab requests or keep medical records, we don’t have enough vital sign monitors (only four in the resuscitation unit and two in the rest of the ER), we have no glucometers or thermometers whatsoever, we don’t have enough sutures or needle drivers, and we have no CT scanner for the ER.

There’s not enough medication either. Many cancer patients died due to lack of access to chemotherapy, and many people have not yet been able to receive formal cancer diagnoses because they can’t get tissue biopsies. The only cancer hospital in Gaza was in an area that has been occupied by the Israeli army since the start of the war. Our priority is to take care of trauma patients during the war.

TK: What do you think about when you think about the future? How has this conflict changed you?

AQ: As a new grad before the war I was thinking a lot about my medical training—taking the USMLE or other international medical exams and applying to residency abroad, specializing outside of Gaza and then eventually returning—but during these eight months, I’ve only been thinking about whether or not I’ll still be alive after the war is over. That is, if the war ends. Some days I think it won’t stop and I’ll be displaced from my home forever. Everyone is displaced and everyone who can is evacuating because there is no life to live here.

Before the war I was living close to al-Shifa Hospital. I heard bombs every second while I was living there for the first week of the war. Universities, towers, and many other buildings were destroyed near where I was staying. I was struggling to breathe because all of the air was full of the smell of gunpowder. Every time we heard a deafening airstrike we imagined that the next one would bring down a building on top of us.

We are only living because we didn’t die. We all think that the ones who died during the war are, in a way, the only ones who survived. Because anyone still alive is only struggling to survive and only afraid of death or injury. In a way the best end for anyone in Gaza is to die quickly. The ones who have survived have seen many wars [clashes] in earlier years (2022, 2021, 2014), and the ones who survive this one will live to see more wars in upcoming years. We are tired from all this. How can we think about our future?

TK: How do you comfort and console your patients, knowing so intimately what they have experienced and knowing the uncertainty of what they face?

AQ: When a patient comes to the ER and they are afraid, I try to make them as comfortable as I can. Of course I can’t relieve their pain or the stress they may have experienced when their house was destroyed or when they lost their loved ones, but I try to be nice to them, to deal with them in a good way, to say good words to them. I try to help them see the good things. Like, if someone has lost their hand, I say Alhamdulillah they have not lost more than this. At least they are not in the ICU or in the operating room. I compare them to people who are in a worse condition. It doesn’t relieve the pain, of course. I can’t imagine myself experiencing what they experience. I am really afraid to see my family in this kind of pain. I can’t put myself in their position. So I try my best, but it’s really difficult. Sometimes you just don’t have the words. I hug them to say that we are with you, you are not the only one who is suffering. It’s very difficult, seeing the pain of others.

During our conversation about comforting patients, Ameera sent me a number of photographs, including one of an infant with a breathing tube and burns over most of their body. The breathing tube is connected to an “Ambu” bag, which is used to breathe for patients by hand in the absence of a mechanical ventilator.

TK: This is a very hard image to see. What happened to this patient?

AQ: This patient came to the ED after an airstrike and [his oxygen levels were dropping] and he was burned on all his face, abdomen, and hands. He was very little. After intubating him I gave him breaths by Ambu bag. I had to keep bagging him for hours while he was in the ER because the only ventilators in the hospital are in the ICU. My hands started to hurt a lot. While I was working with him I heard that he had lost many of his family, and I was very sad, thinking about what his life would be like—but he died also, as did his family, and many people in Gaza.

TK: How do you take care of yourself emotionally?

AQ: Earlier on, during the siege of Nasser, I had no time to take care of myself. I was living in the hospital and only working. I’d get up in the morning, work all day, and then wake up to work again, and so on. I didn’t have the time to do anything else.

During that time I wasn’t talking with my friends. I have many dear friends, but I could only contact them rarely, when I had a moment, and even then it was only to see if they were still alive or not. I couldn’t talk about what I was going through because there was no time.

Do you know the term PTSD? I think if the war and all the genocide stopped, all of the citizens of Gaza will have PTSD. We are all traumatized by what we’ve seen. No previous war was like this, no one has seen all this displacement and all this loss. No one in Gaza has lived through this war without seeing his own loved ones injured or murdered. And while the war goes on, we don’t have the time to cry because every day you have new news, news that is worse than before. It feels like every day you’re going from displacement to displacement. (We were displaced from Gaza City to Khan Younis, and then again to al-Mawasi). When the war stops, it will take a long time for people to escape from the grip of what they have seen, and many may not be able to deal with the stress of what they have seen and been through.

I keep myself going . . . I don’t know . . . really I don’t know how to go on. Work helps. I wake up every morning and know that I can’t stay in the tent doing nothing because I always love to help and to work. I don’t want to sit in a chair in the tent all day waiting for the day to end, so I go to the hospital, help people, work, see my colleagues, talk with them about cases, and that’s how I keep going. Everyone I know is shocked that I was besieged inside Nasser and kept working through the fifteenth of February—and that now I’m back at work there. But I have a strong heart, and I love to help people so that’s what makes me strong and [keeps me] trying.

TK: To change subjects a bit, I saw a photo of you with Dr. Khaled Al Serr, a surgeon. Can you tell me about medical staff who have been detained during this war? What has happened to them?

AQ: Yes, I know Dr. Khaled personally, we had a lot of shifts together, and I always asked him questions about cases. At one point he was the only general surgeon at Nasser. I did a lot of exploratory laparotomies with him. Nobody knows anything about where he is.

I personally know many who were detained inside Israeli prisons, and I know some who are still inside. Dr. Haitham [Ahmed] Kullab, who’s a general practitioner, was a volunteer at Nasser like me, and we were besieged together. Haitham is a dear friend. When Israel entered the hospital, he was evacuating in the “safe passage” that they told us about, but they detained him and asked him to take his clothes off in front of all of his colleagues. He was in prison for a little less than two months and was released a few weeks ago. He’s back to volunteering at Nasser.

Dr. Musab Samaan was in the orthopedic emergency room working with many cases and he was also besieged inside the hospital, and when Israel entered the hospital they took him.

Dr. Ayoub Abu Namer was another volunteer in the ED. They took him in February, and he is now out of prison.

Dr. Hani Al Haitham was the head of the ED at al-Shifa Hospital, and he was murdered during this war. He was a very good person, always active, seeing every case in the ER. When anyone needed anything he would do it. He was very kind, a great doctor, and I am very sad that he is dead.

I couldn’t know [Israel’s] reasons for detaining people. They seem random. A family member of mine was detained during the war for twenty-four days, and then released. I asked him what they asked him while he was incarcerated. He told me that they didn’t even ask him any questions. They released him suddenly and without warning. Twenty-four days of torment only.

It seems like they want to take all the experienced people here. They are leaving us without life. With no experienced doctors, no engineers. They want the people of Gaza to be with nothing, to force us to evacuate the cities. And then they have all of the land.

TK: Have you personally been affected by the lack of sanitary conditions and running water? What are your living circumstances like these days?

AQ: Personally, even though we have some running water in our tent, and even though I clean my hands with soap when I can, I’ve had gastroenteritis fifteen or more times since the beginning of the war—can you imagine this? It’s a very bad situation.

We all experience the same thing. It’s normal because the environment around is very unclean. We live in tents, the sand is everywhere, even when we clean the dishes we see that there’s a little sand in them. You can see the garbage in the street everywhere in huge amounts, and the people living around this garbage are living in tents. There’s no way to prevent yourself from getting sick. We see many cases of hepatitis A and gastroenteritis. My sisters now have [hepatitis A]. It’s a pandemic in Gaza.

We don’t have a fridge at all, and we don’t have electricity most of the time, so we have to make bread every two days on an open fire. At night the camp is very dark. Fuel for cars and buses is so scarce that we tend to walk everywhere, although there is still a bus that picks me up to take me to Nasser. Some people use donkey carts or horse carts to get around, but they’re very slow.

TK: If you had an audience of American physicians what would you want them to know? What would you want them to do?

AQ: I would say that medicine in Gaza is different from medicine in any other part of the world. We see huge numbers of patients losing their limbs, suffering from fractures, losing their kidneys, perforating their bowels, losing their skin. We need your help and support. We need you to send medical missions to Gaza. We need equipment to pass through the blockade and we need expert senior doctors.

TK: In addition to volunteering at Nasser you also find yourself attending to the medical needs of people in the camp, right?

AQ: Yes. Last month a woman came to me and asked me to see her brother, who was having shortness of breath. I ran with her, and she was crying as we went to her tent, telling me that she lost her mother a week ago and her brother a month ago (they were both bombed in their houses). When I saw her brother and started asking about his medical history, he showed me a chest x-ray. There was a white shadow there (it was irregular in shape, like a mass), and after taking a detailed history, lung cancer was on the top of my differential diagnosis. His voice was also hoarse, and his thyroid was large when I examined it. So he had undiagnosed thyroid and/or lung cancer.

He needed a biopsy but didn’t get it because it wasn’t available during the war. I felt deep inside that he would die, but I didn’t have the courage to tell his sister. There was no chance of him getting chemotherapy. So I asked her to take him to the hospital and tell me what happened. After a few days, his sister came to me and told me that he had died.

And I forgot to tell you something that happened yesterday. There was a woman who gave birth in the tent right by me. I was in my tent and then someone started yelling, “The head is coming out!” So I ran to her tent and saw that it was already crowning, so she couldn’t afford to wait for the ambulance to arrive. So I decided to finish her delivery in the tent. I tried to be as sterile as possible. I had my kit, Alhamdulillah, consisting of a needle driver to use as a clamp, gauze, and sterile gloves, and finished the delivery of a very beautiful female baby. The mother didn’t have postpartum hemorrhage, thank God. It went very well, and I was really proud of myself.

It feels very different delivering a baby in a tent. When I was training in the al-Helal al-Emirati Maternity Hospital, I did many normal deliveries. But yesterday my hands were shaking. I was very afraid. When she opened her legs I saw something that looked like a placenta and I felt my heart beating fast because I thought it was a case of cord prolapse, but when I focused I saw the head of the baby, so I took a deep breath from inside and asked her to push. I was happy that I had sterile gloves so she would not suffer from infections because of me. When she started pushing the baby came out easily and started crying. It was the most relieving sound during this time. But Wallah, when I remember the situation I feel my heart beating again.

Postscript: A few days before this interview was set to publish, Ameera sent me a string of messages that flirted with despair. The situation in al-Mawasi was becoming increasingly dangerous: tents not far from hers had been bombed and their tenants burned alive. Neighbors were packing up and moving back to wherever they had fled. She could hear airstrikes nearby while composing the messages. “We have many choices of dying,” she wrote, “dying by airstrike, dying by tank shell, dying from the walls of the home that will be destroyed on top of us . . . or we can stay in al-Mawasi and burn in our tents.” She said that she felt powerless and that she was, above all, exhausted. She spoke about envying her uncle Hamada who had been killed in October: “The best end is dying in peace. . . . He only lived sixteen days in this war while we have lived almost nine months.”

I sat with Ameera’s words for a while and eventually acknowledged to her that my words would change nothing, and that essentially I had no words of comfort. But I reminded her that she had felt this way before and had still found strength to continue on, and that things had gotten better, for a time. I told her that I could imagine another end for her—that a lot of people could imagine an end—where she could finally rest in safety, and where she could properly grieve.

A day later she sent me a smiling selfie from a new volunteer gig—on top of her work at Nasser—where she has just begun to educate new mothers on breastfeeding technique and gather research data on infant malnutrition. She said that she felt a bit better. Along with the selfie she also sent photographs of destroyed buildings around the Palestinian Red Crescent Society in Khan Younis.

As the situation in al-Mawasi has become increasingly dangerous, Ameera has made the difficult decision to move back to a family home in Khuza’a, a village near the border with Israel which has been largely depopulated since the start of the war. There is no bus that goes from Khuza’a to Nasser currently because the roads in Khuza’a are strewn with rubble. Ameera has charted out her potential commute to Nasser: it will involve walking two kilometers through rubble to get to a bus stop on her way in, and two kilometers to get home from the bus stop at the end of the day. She says she will carry on no matter what.