Gaza: Medical care through war and truce

For 50 days, Gaza’s Al Shifa hospital has lived to the rhythm of fighting followed by ceasefire followed by fighting again. Then on 25 August, an open-ended ceasefire came into force, bringing a massive sense of relief to MSF teams and to the population of Gaza as a whole. But activity in the largest hospital in Gaza continues unabated. Until yesterday, the hospital was still receiving people wounded in recent bombings, as well as people injured over previous days who were unable to come for treatment until now.

Chest and abdominal injuries
MSF surgical teams continue to work shifts at Al Shifa hospital, alongside Palestinian Ministry of Health staff, as they have been doing since the Israeli army launched Operation Protective Edge on 8 July. As one MSF surgeon leaves, another one takes their place. Maurice, a thoracic surgeon, has just returned from Gaza. "I was operating on patients with chest and abdominal injuries,” he says. “Most were shrapnel wounds. Even a small piece of shrapnel less than 1 cm long can tear everything in its path and cause massive wounds to the lungs. More than half of the patients I operated on were women and children. "

Two other MSF surgeons are currently working in Al Shifa hospital, operating on patients with severe burns who require multiple surgery, doing plastic surgery and carrying out skin grafts, amongst other things. They are also called on to assist with especially difficult or long operations. The 60-bed Al Shifa hospital receives patients from across the Gaza Strip, and includes six operating theatres, an intensive care unit where burns victims are cared for, and an emergency room. The Palestinian medical staff are very experienced, but a number of hospitals in Gaza have been destroyed or damaged, and the workload in Al Shifa is so heavy that they still need outside support.

Constant flux of wounded
From 28 July to 10 August, MSF had three surgical teams working in Al Shifa hospital. There was a constant influx of wounded to the hospital during the ground offensive. The emergency room was overwhelmed, as were the operating theatres, with 30 to 40 seriously wounded patients arriving each day.

"Many patients had multiple shrapnel wounds caused by explosions, with chest, vascular and limb injuries,” says Kelly, an anaesthesiologist who spent almost four weeks in Gaza. “People in the vicinity of an explosion are burned by the heat, while the blast destroys their lungs and shrapnel penetrates their body. The shock wave can destroy the leg bones of a person who is standing, and both legs then need to be amputated – it's terrible, but there’s no other solution. "

Post-operative care
In seven weeks, MSF has sent 37 international staff to Gaza, including surgeons, doctors, nurses, administrators and project coordinators. Currently MSF has two surgeons, two anaesthetists and one intensive care nurse working in the hospital.

MSF also runs a clinic in Gaza City providing post-operative care to patients who have undergone surgery, who come to have their dressings changed and to attend rehabilitation sessions with a physiotherapist.

Dressing kits for patients
Activities in the post-operative care clinic over the past seven weeks have been dependent on the intensity of the attacks. At the height of the war, the clinic closed for 11 days, as it was impossible for patients either to reach the clinic on their own or to be fetched by MSF car. During this time, the team provided dressing kits for patients. When the clinic reopened, 20 to 40 percent of patients were able to come for their appointments. A number of patients, however, have still not been traced. Now the clinic is full. "It's like a beehive,” says Dr. Abu Abed, MSF doctor. "As well as our former patients, we have been caring for new patients who were injured during the war. We saw more than 100 new patients between 1 July and 25 August. "

The medical aid MSF is providing in Gaza takes a number of different forms. As well as working in Al Shifa hospital and the post-operative care clinic, MSF has also ​​donated drugs and medical supplies to the central pharmacy in Gaza, to Al Shifa hospital, to Nasser hospital in Khan Younis and to Kamal Edwan hospital in Beit Lahiya. Perhaps most significant has been the successful collaboration between MSF teams and teams from the Palestinian Ministry of Health. With the blockade cutting off the entire population of Gaza from the outside world, in recent years Palestinian medical staff have been deprived of opportunities to share skills with international colleagues, to gain practical experience or to travel to medical conferences abroad. As a result, they have been appreciative of the chance to learn new surgical, anaesthetic and medical practices from MSF’s teams.

MSF has 50 staff working in Gaza: 40 Palestinian staff and 10 international staff. MSF also works in the West Bank, running a psychological support programme in the governorates of Hebron and Nablus.