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Inside Gaza’s Nasser Hospital, healthcare workers suffer trauma, burnout, and loss

‘We don’t have the luxury of pausing to grieve.’

We see two ambulances outside of a hospital. Mohamed Solaimane/TNH
Ambulances delivering victims to the emergency room at Nasser Medical Center in the city of Khan Younis in the southern Gaza Strip. A third of the hospitals in the enclave have been forced to shut down by Israeli airstrikes and fuel shortages.

After 26 days of intense Israeli shelling and bombing, healthcare workers in the Gaza Strip are feeling the enormous strain of attending to a constant stream of wounded and dead, with insufficient medical supplies and an electricity supply dependent on back-up generators running low on fuel. Many of the victims they see are children, sometimes their own. 

Mohamed Abu Mousa, a radiologist, has only left work at the Nasser Medical Centre in the southern Gazan city of Khan Younis for a couple of hours since Israel began bombing the enclave on 7 October. One of his few trips outside the hospital was to bury his son, Youssef. 

The seven-year-old was killed – along with one of Abu Mousa’s nephews – when the family’s home was reduced to rubble by an Israeli airstrike on 15 October. After laying his son to rest, he immediately returned to the radiology clinic to continue working.

“We don’t have the luxury of pausing to grieve,” Abu Mousa, composed yet exhausted, told The New Humanitarian. “The heartache is immense, but the wounded are endless. We have to keep going.”

Abu Mousa’s son is one of at least 3,648 children killed in Gaza since 7 October, according to the Health Ministry in the enclave, which is governed by the political and militant group Hamas. That number surpasses the annual total of children killed in all of the world’s conflict zones during any of the past three years, according to Save the Children.

A further 1,000 children are reported missing in Gaza and are thought to be buried under rubble, meaning the actual death toll is likely significantly higher, the NGO said.

Overall, more than 8,796 people have been killed and more than 22,200 wounded since 7 October, according to the Gaza Health Ministry, and an estimated 1.4 million people, out of a population of around 2.3 million in the enclave, have been displaced from their homes, according to the UN.

The Israeli military has been bombarding Gaza since Hamas launched a deadly incursion into Israel on 7 October, killing around 1,400 people – many of them civilians – and wounding close to 4,500 others, according to the Israeli Health Ministry. Hamas also took around 200 hostages back to Gaza, many of them civilians from around 25 different nationalities.

On 27 October, Israel began a land invasion of the enclave, and it has imposed a total siege on the territory since 9 October, cutting off water and electricity, blocking the entry of food, fuel, medical supplies, and other essentials, except for a small trickle of humanitarian aid that has been allowed to enter through the Rafah border crossing with Egypt. 

Healthcare workers in the besieged territory have been working around the clock even as Israel has repeatedly ordered administrators to evacuate hospitals – something the World Health Organization (WHO) has called a “death sentence” for the sick and injured.

Sixteen of the enclave’s 35 hospitals have been forced to shut down due to damage or lack of fuel, and at least 130 healthcare workers have been killed, according to the Gaza Health Ministry.

Hospitals that remain functional are only operating at one third of their normal staffing levels due to the high number of medical workers who have been displaced and killed, according to a situation report from the UN’s emergency aid coordination body, OCHA.

Those who are able to work are left with scarce resources. Medical workers are increasingly having to improvise to attend to the wounded, reliant on help from volunteers as more and more health facilities and ambulances are rendered inoperative by Israeli missiles.

The New Humanitarian visited the Nasser Hospital daily for over two weeks, talking to staff and documenting the toll that Israel's ongoing bombardment is taking on their lives and their ability to provide care to the wounded.

‘They’ve hit Abu Mousa’s house’

Abu Mousa recounted the day, just over two weeks ago, that he found out his home had been bombed and Youssef had been killed.

He was in the hospital when he heard the thundering sound of yet another air raid – the bombardment had already become a constant. “I called my wife. She didn’t answer, but her phone rang as normal, so I was slightly relieved and kept on working,” Abu Mousa said. “I tried calling her again a little while after, and when she did pick up the phone, there was screaming. My heart sank.”

He couldn’t leave his work to find out what happened because a fresh round of frenzy had taken hold as corpses and injured bodies from the airstrike were rushed into the hospital by medics and volunteers.

“I heard someone say, ‘They’ve hit Abu Mousa’s house’. And I ran to the outpatient department to find my wife and surviving kids, injured and devastated. They didn’t know where Youssef was,” he said.

In a video of what happened next, Abu Mousa rushes from one room of the hospital to the next, desperately asking everyone about his son and receiving silence in response until someone tells him Youssef is in the mortuary.

The video has become symbolic of the awful reality facing healthcare workers in Gaza, attending to the injured non-stop and never knowing when their own family members may be brought in as victims.

Abu Moussa’s family – including his 13-year-old daughter, Joury, who suffered serious injuries to her limbs – are now among the thousands of displaced people who have taken shelter inside the Nasser Hospital.

‘Constant fear on top of the exhaustion’

Like many other hospitals in Gaza, the Nasser Medical Centre has also had close calls from Israeli missiles. “An airstrike once fell right there, right outside the hospital’s doors,” Noureddein al-Khateeb, a 38-year-old resident doctor in the emergency department, told The New Humanitarian, pointing to the building across from the hospital.

It wasn’t the only time Israeli missiles had struck close to the hospital, al-Khateeb added. 

“We live in a constant state of threat and fear,” he said. “And we’re also afraid for our families’ safety, but what can we do?”

Doctor Noureidden al-Khateeb leans over the hospital bed of a child who is covered in a space blanket and has suffered burns in their face.
Mohamed Solaimane/TNH
Dr Noureddein al-Khateeb attending to a young child at Nasser Hospital.

As Israel began a ground invasion and continued heavily bombarding the enclave, all cellular service and internet connectivity was cut in Gaza for roughly 36 hours between 27 and 29 October. Al-Khateeb said he was unable to communicate with relatives to know whether his house and family were among those that were being hit. 

“It’s constant fear on top of the exhaustion we’re experiencing. But one shouldn’t think of that too much. I can’t. If I do, I won’t get any work done,” said al-Khateeb, who had clear signs of fatigue on his face.

Several videos posted online over the course of the past three and a half weeks show healthcare workers breaking down when they learn their relatives have been killed, or after witnessing the carnage caused by airstrikes. In one, a nurse wearing medical gloves on her hands wails, “O God, we’re done. We can’t keep going. O God, we’re over.”

‘I learned of their death while on shift’

As the Israeli assault continues, the corridors of the Nasser Hospital are increasingly lined with patients. Bed occupancy has reached 160%, doctors told The New Humanitarian.

Mahmoud al-Astal, a nurse in the hospital’s emergency department, was unable to attend the burial of his sister’s husband and their four children – just some of the many relatives of medical staff who are among the thousands killed by the Israeli airstrikes.

Breaking down in tears, al-Astal said: “I learned of their death while on shift, and there is barely enough of us to handle those in need of help. I couldn’t be there for my family.”

Working under such difficult conditions, the hospital staff have developed a close sense of camaraderie and have established an “invaluable” support system among themselves, according to al-Astal. “But the damage done to our souls is too deep,” he added.

Like many colleagues, al-Khateeb feels a strong sense of duty to care for the endless stream of wounded. He has only left the hospital a handful of times since 7 October, battling exhaustion and fear. “Do we have another option?” he asked. 

“At times, the cases brought in were way more than the hospital’s bed capacity, and they’re mostly critical cases that need immediate attention,” al-Khateeb said. “You’re expected then to make a call within seconds: Who will you save, and who will you leave to die? You don’t have the time to pause and think. You just act.

“We encounter the most difficult sights and painful cases. Blown up brains, punctured bodies and organs, and the killed or devastated children… Things that are beyond comprehension,” he continued. “But as you respond, there is no room for emotions. It’s when the madness briefly quietens, and you’re alone, that the details and images come back to haunt you.

“I try to push them away in order to keep going. Some of us couldn’t do that and collapsed,” al-Khateeb said, looking around the hospital’s bustling corridors. “But this must stop. We can’t keep going much longer.”

Lack of resources add to pressure

The Nasser Hospital is “on the brink of collapse due to us running out of supplies”, Dr Ayman al-Astal, the head of the emergency department who shares the same surname as the nurse, told The New Humanitarian.

Head of the A&E of Nasser’s medical center Doctor Ayman Al-Astal stands in front of an ambulance. He is wearing medical scrubs.
Mohamed Solaimane/TNH
Dr Ayman al-Astal, head of the emergency department at Nasser Hospital.

Between 21 October, when Israel began allowing a limited amount of aid to enter Gaza through the Rafah border crossing with Egypt, and 31 October, a total of 217 trucks carrying humanitarian relief entered the enclave. Of those, at least 75 carried medical supplies, according to OCHA. There is an urgent need to restock medical supplies to address shortages, according to the OCHA situation report.

Al-Astal said surgeons at the Nasser Hospital have “had to operate on patients without applying anaesthesia or [give them] conservative treatment because of our inability to surgically intervene because of limited supplies”.

Admitting that his team is showing symptoms of depression, burnout, anxiety, and trauma, al-Astal said the supply shortages add an additional burden on healthcare workers.

“It’s painful to receive the severity of the conditions the wounded come in, but it's much more painful to stand with tied hands, unable to help,” he said.

Asked if the staff fear for their lives as hospitals are increasingly affected by Israeli strikes, al-Astal said: “We’re not leaving. We are martyrs in the making.”

This feature is produced in collaboration with Egab. Edited by Eric Reidy.

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