GAZA CITY, Gaza Strip – In the heart of Gaza City, as its residents again find themselves under fire from Israeli forces, the wounded and their wailing families stream without end into Shifa Hospital.
Shifa, Gaza’s largest hospital, only has an 11-bed emergency room and six surgical theaters. Yet amid power cuts and among the screams of the bereaved, doctors at the 600-bed facility have become masters of improvisation, forced by the seemingly unending conflict engulfing the coastal strip to care for the wounded.
“If we are in the middle of an operation (and) lights go out, what do the Palestinians do?” said Dr. Mads Gilbert, a Norwegian who has volunteered at Shifa on and off for 17 years. “They pick up their phones, and they use the light from the screen to illuminate the operation field.”
The wounded from Israeli strikes usually arrive in waves. Thousands of Palestinians already have been wounded in the fighting, health officials said. Many, including the most serious cases, end up at Shifa.
A new wave of casualties recently arrived after daybreak July 20, following a night of heavy Israeli tank fire on the Shijaiyah neighborhood in Gaza City. Hospital guards shout at drivers to move to make room for the next vehicles, pushing back journalists and onlookers.
Some of the wounded are treated in a hallway near the emergency room. A medic bandages the foot of an emergency worker writhing in pain on a mattress on the floor. A little boy with shrapnel wounds arrives, and the emergency worker slides off the mattress to the hard floor to make room for the child.
Nearby, a woman cries hysterically. A man holds up a dead child, wailing. Another carries a teenage girl whose right arm is bloodied and broken.
Patients on gurneys line up outside the X-ray room. Relatives of the wounded, one in a blood-soaked white undershirt, argue over who will be examined first.
Dr. Jihad Juwaidi said his six surgical rooms quickly filled up and that even the seriously wounded have to wait for surgery, including a little girl with a fractured skull.
Choosing who is treated first is gut-wrenching, said Dr. Allam Nayef, who works in one of Shifa’s intensive care units.
“Sometimes you have to select which one of them has the best chance to survive,” Nayef said. “Easily in this rush, you can take a bad decision, that the one (patient) you thought will wait for you ... you won’t find him when you finish your surgery.”
Nayef and his colleagues work 24-hour shifts. A storage area crammed with boxes and an old vinyl-covered sofa doubles as a lounge where the doctors rest until the next wave.
Even in peak hours, there is some order in Shifa’s seeming chaos.
This is the third round of major hostilities between Israel and the militant Islamic group Hamas in slightly more than five years. Everyone at Shifa – doctors, nurses and bearded Hamas police officers in blue camouflage uniforms – knows their part during a crisis
Working at Shifa requires ingenuity.
The power goes off repeatedly as aging hospital generators buckle under daily rolling blackouts Gaza residents have lived with for years. Many items are in short supply, from gauze to adrenaline. The staff also lacks spare parts for worn equipment, with bedside trolleys clattering down hallways on rusted wheels.
Only three of Nayef’s four intensive-care unit beds have ventilators. One broke down long ago and can’t be repaired. He said he once made a special wire for cardiac pacing from a spliced Ethernet cable.
Shifa’s problems began well before this round of fighting. They are rooted in the decades-old Israeli-Palestinian conflict and more recently in the rivalry between Hamas and Western-backed Palestinian Authority, led by President Mahmoud Abbas.
Israel captured Gaza, the West Bank and East Jerusalem in 1967. However, Israel withdrew from Gaza in 2005, leaving it to the Palestinian Authority, and Hamas seized the strip in 2007.
In response, Israel and Egypt have blockaded Gaza, restricting trade and movement. The blockade has set Gaza back years, and now the growing financial problems of Hamas and Abbas’ Palestinian Authority, based in the West Bank, have compounded the shortages.
Israel said it allows in medical supplies except for “dual-use” items – anything it suspects could be diverted by Hamas for military purposes – but won’t say what it has blacklisted.
Gilbert, the Norwegian volunteer, helps out at Shifa several times a year. This time, he brought headlamps, useful for surgeons, but said they are on Israel’s list of banned items.
He feels a strong personal bond with his Palestinian colleagues, saying they provide good care under challenging circumstances, but feel hurt by the world’s seeming apathy toward Gaza.
Gilbert, 67, currently is the only foreign doctor at Shifa.
“I am not the hero,” he said. “These people are the heroes. When we leave, they stay behind.”