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Steady hands needed for surgery were often shaken by Israeli bombs falling close by, complicating the already dire conditions at the European Hospital in Khan Younis, where Dr Mohammed Hisham Naji was volunteering.
The Syrian-American anaesthesiologist describes moments in which it was impossible to hide his anxiety as ceilings trembled under the sounds of Israeli planes.
But developing a calm bedside manner became a mutual practice between patient and doctor.
“The people of Gaza, they look at us and say, 'What's wrong? That's normal, it's OK. We get used to it.' So we got our calmness and comfort from them,” Dr Naji tells The National.
Like that of many people around the world, Dr Naji's social media feed has been flooded with images of anguish in Gaza as Israel continues its war against Hamas in the densely populated enclave.
Seeing the destruction unfold online compelled him to leave the safety of his home in the Washington suburbs for what is now one of the most dangerous places to practise medicine.
A viral video of a fellow doctor in Gaza who was forced to amputate his own daughter's leg without anaesthesia served as the final push.
“I said to myself, I'm an anaesthesiologist. My job is to help people, and I'm going to take the risk and go.”
Dr Naji has volunteered his medical services in dangerous corners of the world before. An active member of the Syrian-American Medical Society, he travelled to Turkey following last year's earthquake, went on several tours of northern Syria amid the continuing civil war, and lent his services to refugee camps in Jordan and Lebanon.
But none of this, Dr Naji stresses, compared to the horror he witnessed during his two weeks in Gaza. He entered the territory at the Rafah border crossing with Egypt.
While he considers himself to be a “shy man”, his experience in Gaza mandates a decidedly loud return to the US.
“The world needs to say enough is enough. We need to have complete ceasefire and rebuild the life of those people,” he says.
“This is not a war between two armies. This is a campaign of bombing and killing by the most powerful army in the world.”
Israel's military campaign, which began after the October 7 Hamas attack, has killed almost 30,000 Palestinians, according to local health authorities.
But Dr Naji, a rare outside witness to the situation in the increasingly isolated enclave, believes that toll to be much higher, as “so many people are buried deep in the ground under the rubble”.
As a physician, however, he stresses that “the most important ones are the ones who didn't die”.
“They live with amputated leg, amputated arms, severe deformities, burns – we've seen kids that their body is burnt from top to toes,” he says.
“Those people have no medical facility to take care of them, no physical therapy, no rehabilitation.
“Who's going to take care of them?”
He becomes emotional as he describes treating one patient, who, along with her son, had been severely injured.
The mother's arm had to be amputated after it “shattered into pieces”, while her teenage son arrived with zero blood pressure and several injuries to his abdomen.
“We give him blood, we gave him plasma, all that we can, for about 45 minutes – we thought he was going to live,” he says, choking up.
“But he didn't make it. He died that night. And then his mother, when she woke up from the anaesthesia, she lost her arm. But the first thing she asked was, 'My son, how's my son?'”
Dr Naji recalls the words of a Palestinian anaesthesiologist, among those continuing to work amid the raging siege, that “he will never forget”.
“We know we're going to be killed, but we don't know when,” the Gazan doctor said.
“We are here like somebody who was sentenced to death in a prison.”
Patients moved from besieged Nasser Hospital in Gaza – video
But the doctor told Dr Naji: “We're not afraid.”
Hope and despair, acceptance and anxiety, loss and life – all are in a constant state of collision in Gaza. The through line, however, is resilience.
“What we learnt there, actually, from the people of Gaza is their resilience that is unbelievable, especially the young ones,” Dr Naji says.
“There will be frequent bombing and they will continue to talk with each other and laugh and play and walk around.”
There are moments of joy and celebration, with the locals even throwing Dr Naji a going-away party on his last night in Gaza.
The Syrian-American doctor returned home to his anxious family two weeks ago, though the experience has left him “feeling like I am still living there”.
“The impression that it gets inside you, it's hard to erase it. I think that feeling will slowly get less but I think this is the most impressive trip that I've ever made in my life.”
He has a call for fellow doctors, too.
“I would tell all physicians who can hear me: don't hesitate to go,” he says.
“We all believe, whether Muslim or Christians, your day, when it comes it comes, regardless of whether you're in your own bed or under bombing.”
Now at home, Dr Naji is grappling with his own form of survivor's guilt.
“Actually the worst feeling in my heart is when I was leaving and saying goodbye … They look at your face and they say, 'Wow, you're able to leave, we cannot leave. We're here waiting for our destiny,'” he says.
“And I wish I could stay longer. And I would not even hesitate to go back again.”
