In late January, we helped organize a group chat between doctors from around the world and Dr. Khaled Alser, the only general surgeon remaining at Nasser Hospital in southern Gaza.
Less than a year ago, Nasser Hospital was home to ten surgeons and ten surgical interns. Now 31-year-old Alser, a recent graduate of surgical training in Gaza, was the sole surgeon leading a smaller team faced with a tsunami of trauma patients without many of the specialists or resources we have in trauma centers around the world. take for granted.
They had very limited medicines or medical equipment and faced interruptions in basic services such as power or water. However, the team was determined to provide as much as possible the standard of care they had learned during medical school and training, and Alser contacted Palestinian doctors (including author Osaid Alser, a relative) abroad to expand the group.
Early in the group chat’s life, we reviewed a series of cases of civilian trauma patients from military weapons. Alser shared with us the emergent abdominal examination of a three-year-old girl after an Israeli airstrike on her home, which required repair of her stomach and removal of her spleen. Pediatric surgeons in the group provided assistance and the patient was successfully discharged in good condition.
Alser sent images of the mutilated extremity of a nine-year-old child who, we all agreed, would need an amputation of her leg – as more than a thousand children in Gaza have needed since October. We provided advice on how to save as much of her leg, skin and soft tissues as possible to give the child the best possible chance of recovery.
And Alser told us about the 25-year-old man with extensive shrapnel injuries to his neck and face, which required immediate examination and repair. Nasser’s team received advice on additional surgical care from otolaryngologists and maxillofacial surgeons who reviewed the CT scan and operative images of the patient’s shattered jaw, and praised the damage control and reconstruction performed by Alser.
Alser also sought advice on how to treat many gunshot and shrapnel wounds to the brain, while no neurosurgeon could reach the hospital during the Israeli siege. Some injuries were simply unsurvivable, such as the case of a 70-year-old grandmother who was shot in the head by a sniper. In another case, neurosurgeons in our group helped Alser decide how and when to operate, beyond the scope of his previous training, by sharing drawings and videos of specialized techniques.
As we reviewed these clinical cases, many of us realized the threat looming over the hospital and physicians on the other side of our group chat. We knew that the violence against hospitals and health workers was moving south, towards Nasser Hospital. But it was still shocking when the chat shifted from clinical images of patients to requests for prayers for staff safety in early February.
The last series of posts in the group described an onslaught of patients being injured on hospital grounds, including a video sent to our chat by the surgeon of an operating room nurse being shot in the chest while working in the surgical wing of the hospital.
We attempted to guide the treatment of this nurse’s injuries based on his imaging and examination results, just as we had done with the patients who came before. The doctors also shared video footage of injured patients in the hospital courtyard who were unable to enter the building due to ongoing shooting until one of the midwives, Dr. Ameera Elasouli, braved the incoming fire to examine the patient and facilitate their evacuation inside for treatment.
As the hospital’s security situation deteriorated and the internet became spotty, Alser left audio messages with detailed Israeli orders to leave the hospital or the hospital would be bombed. He stayed at the hospital along with other doctors and nurses to treat his patients beyond the deadline set by the military. The next message was about the subsequent bombing of the hospital, which killed one patient in their hospital bed and injured others.
In a subsequent attack by an armed drone, one of the doctors we were supporting was shot in the head. Although this doctor should have made a good recovery, the bullet was just inches away from killing him.
The messages detailed the chaos and terror felt by hospital staff and patients at the time, including voice notes showing explosions heard on the hospital grounds. Despite their best efforts to treat the injured, Nasser’s staff eventually sent us a video of the hospital evacuation. Alser sent us videos of patients who died when their life support was cut off due to interruptions in electricity and oxygen supplies during the hospital siege. We have received no word on the fate of the rest of the ICU patients and premature babies who cannot be evacuated. We fear that their fate will be similar to that of the premature babies who were left to die and rot in isolation at al-Nasr Children’s Hospital in Gaza City after it was forced to evacuate.
The messages became increasingly erratic and then: radio silence on Thursday, February 15.
From other news media we saw images of Israeli soldiers occupying Nasser Hospital, taking many health care workers into custody and putting the facility out of service. For three days we worried about Alser’s safety. He finally replied: “I am still at Nasser Hospital among my patients, but many of my colleagues have been arrested. In short, I lived in hell for three days… What happened to the… doctors, patients (and) relatives is unbelievable, even in your worst nightmares.”
There are divisions within the international medical community over how to deal with the ongoing war in Gaza. Many have chosen not to participate at all, but for those of us on this chat there has been solidarity since October, when British-Palestinian plastic surgeon Dr. Ghassan Abu Sittah stood on a podium at an impromptu press conference surrounded by bodies , civilians were killed in an explosion on the Ahli Baptist hospital campus.
We remember the Israeli bombing that killed four department heads of al-Shifa hospital, including the heads of obstetrics and gynecology (Dr. Sereen al-Attar), internal medicine (Dr. Rafat Lubbad), emergency medicine (Dr. Hani al -Haytham) and pathology. (Dr. Hosam Hamada).
We heard Shifa’s only nephrologist, Dr. Hammam Alloh, when he told an American interviewer, “we are being exterminated,” shortly before he was murdered along with much of his family.
We remember Shifa’s senior burn/plastic surgeon, Dr. Medhat Saidam, who had been a mentor to one of the co-authors of this article before he was murdered along with thirty members of his family in October. Just the day before this group chat started, two Palestinian medics were killed by Israeli forces while responding to disturbing calls for help from five-year-old Hind Rajab.
Through our phones, we have witnessed in real time the destruction this war has systematically wrought on Palestinian healthcare workers and healthcare institutions in Gaza.
Shortly after our communications with the doctors and nurses in Khan Younis were cut off, we read in the news that Israeli spokespeople were making new accusations against the Nasser Hospital, just as they have been making accusations at one hospital after another in Gaza. This time they justified the attack by claiming that Israeli hostages were being held there. It is almost impossible to refute every accusation that has been made, but it is clear that the intended and actual result of this campaign has been the systematic destruction of the healthcare infrastructure for Palestinians in Gaza, and this has been repeated from north to south.
The UN International Court of Justice has found plausible evidence of genocide in Gaza. While our clinical records may one day be submitted as evidence before the judges in The Hague, in accordance with the Convention on the Prevention and Prosecution of the Crime of Genocide, this is unlikely to come in time to alleviate the suffering of survivors.
It will not treat the wounded or bury the dead. It will not return the hundreds of dead healthcare workers to their families, communities and patients.
It is our moral obligation as fellow physicians to support our colleagues in Gaza in their efforts to treat their patients with the care and dignity that all people deserve. Without immediate and dramatic action from influential actors on the world stage to end the violence in Gaza, it is difficult to see how that will be possible.
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Dr Simon Fitzgerald is from Brooklyn, New York-based trauma surgeon and surgical intensivist with research experience in injury and violence prevention, as well as trauma and general surgery
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Dr Osaid Alser is a Palestinian from Gaza who is training in general surgery in Texas. He is also a clinical researcher with interests in global surgery, surgical capacity assessment and capacity building in war-torn areas and low-to-middle income countries.