War leaves Gaza's health care in critical condition

Shattered glass lies across a bed in a clinic in northern Gaza where walls were blown out by the force of Israeli air strikes. Hospitals were damaged, ambulance routes hit and doctors killed as health care facilities across the Palestinian territory came under fire in this month’s conflict. At the clinic in Beit Lahia, a sign indicating a doctor’s room clings to the wall beside a deep crack. An acrid smell pours from a burnt-out room where a twisted and blackened ceiling fan hangs in the air. “They didn’t warn anyone they would attack,” said Amr Jaber, 41, who worked in administration at the health centre. “It’s by chance that there was no one here,” he said of the blast that hit one evening. A municipality building was bombed next to the health centre, which was damaged to such an extent it is unusable. "It's a clinic for primary care, then they turned part of it into a place for coronavirus testing and to give coronavirus vaccines," Mr Jaber said. In one window, a ripped sign for testing is framed by shards of glass. About 21 hospitals and health facilities were damaged in the 11-day war between Israel and Gaza militants, according to the World Health Organisation. Dozens of clinics were closed during the conflict because there was no way of guaranteeing staff and patients would reach them safely. In central Gaza, one attack destroyed the top floor of a multi-storey building. The debris flew across the street and hit the enclave's coronavirus testing laboratory, temporarily putting it out of action. The Israeli military says such sites are marked as “sensitive infrastructure” and were not targeted directly. It accuses Hamas, which rules Gaza, of installing military facilities among civilian infrastructure. Roads leading to Gaza City’s main Shifa hospital were hit during the war, while at least two prominent doctors were killed. Ghassan Abu Sitta, a British-Palestinian surgeon, said Shifa was under severe strain as fighting raged. "A lot of the wounded were coming there and you feel that this is a system that is being put under so much pressure," said Dr Abu Sitta, who works for the medical charity Doctors Without Borders (MSF). “The pressures of these continuous cyclical wars and Covid on the ministry of health means it can barely provide the basic service,” he said. Dr Abu Sitta has travelled to Gaza repeatedly to treat those injured in war, providing much-needed expertise as a plastic and reconstructive surgeon. “When you create the conditions in which war injuries become an endemic disease, it means that you need a higher percentage of orthopaedic surgeons, of vascular surgeons, of plastic surgeons, than any other natural place would,” he said. Wounded children in particular will need numerous surgeries as their bodies grow, including a girl Dr Abu Sitta operated on who lost half her nose and one side of her face. Marwan Abu Sada, Shifa’s director of surgery, described the devastating wounds treated at the hospital. “We have seen injury to the brain, injury to the chest, neck, lower and upper limbs, multiple wounds, multiple lacerations, internal organ damage, chest injury damage,” he said. Sixty-six children were among 256 Gazans killed, while nearly 2,000 people were wounded, including more than 600 children, according to the UN. With the Israeli crossings into Gaza closed during most of the conflict, medical teams exhausted their supplies. “We started to run out of the already, always chronic shortage of essential medicines,” said Sacha Bootsma, head of the WHO’s Gaza office. “They were running out of the consumables and drugs to treat the seriously injured patients,” such as anaesthetics and syringes, she said. While the ceasefire brought relative calm to emergency rooms, hospitals are still plunged into darkness during the frequent electricity cuts. Doctors rely on generators to continue treating patients, but a lack of fuel during the war meant two hospitals stopped functioning. "We have a shortage of medical disposables, supplies, equipment," Dr Abu Sada said. Fourteen years into a blockade imposed on Gaza by Israel and Egypt, importing new medical equipment or maintaining instruments is a lengthy process. "You have to send it outside, you need at least three months to get it outside Gaza," Dr Abu Sada said. "It is very difficult, really." In the days following the ceasefire agreed by Hamas and Israel, Gazans began cleaning up the damaged clinics and hospitals. Health workers are stocking up on essentials while the crossings with Israel are open for humanitarian aid. "It's not yet a guarantee that we're out of the woods, so now is also the time to ensure that we have a better fuel supply, fuel reserves in place, and the items that have been used up are replenished," Ms Bootsma said. “We all fear the worst, we do not think that this ceasefire will be continuing for very, very much longer,” she said.

War leaves Gaza's health care in critical condition

Bomb damage and chronic shortages add to strain of dealing with a flood of wounded