The Collapse of Gaza’s Healthcare System

British-Palestinian surgeon Ghassan Abu-Sittah on working in Gaza’s hospitals

On Monday, December 11, Dr. Ghassan Abu-Sittah  spoke at an online event hosted by the Palestine Program for Health and Human Rights­, a partnership between Harvard’s François-Xavier Bagnoud Center for Health and Human Rights and Birzeit University’s Institute of Community and Public Health, located in the West Bank. | COURTESY OF HARVARD FXB CENTER

On October 11, Ghassan Abu-Sittah arrived at Al-Shifa Hospital in Gaza City. A few days earlier, Abu-Sittah—a British-Palestinian plastic and reconstructive surgeon—had left his medical practice in London to treat the mounting number of civilians wounded by Israel’s bombardment of the Gaza Strip, commenced in the wake of Hamas’s October 7 terrorist attack on Israeli civilians. When he arrived at the hospital, Abu-Sittah was overwhelmed by what he saw. “From the very start, the sheer number of wounded, and the complexity and severity of the injuries, consumed the capacity of the health system,” he said at a December 11 online event hosted by the Palestine Program for Health and Human Rights­, a partnership between Harvard’s François-Xavier Bagnoud Center for Health and Human Rights and Birzeit University’s Institute of Community and Public Health, located in the West Bank.

Since then, Abu-Sittah said, the healthcare infrastructure in Gaza has deteriorated as the number of patients has increased: at least 50,100 people have been wounded and 18,412 killed in Israeli attacks since October 7, according to the health ministry in Gaza. (Israel has stated that the high civilian death toll is an unfortunate consequence of Hamas’s use of hospitals and other civilian locations, though the death toll has drawn criticism from other countries, the United Nations, and an increasing number of voices within the United States.) Abu-Sittah left Gaza in the middle of November after Al-Ahli Hospital—Gaza’s last still functioning—ran out of anesthetic. For 43 days before that, he had traveled among hospitals to treat wounded patients. He called the situation on the ground a “self-fulfilling catastrophe,” as the bombardment and siege continue to not only kill and wound civilians, but also make the recovery of many survivors difficult or impossible.

Abu-Sittah recalled specific instances when the circumstances of the war made treatment and recovery difficult. On one night, he said, he performed amputations on six children. “One of those kids was a three-year-old, on whom I had to do an upper-limb and a lower-limb amputation,” he said. Even after the surgery, he worried about who would care for and feed the child in the hospital ward: “He was the sole survivor in his family. We didn’t know his name.” By the last week Abu-Sittah was in Gaza, Al-Ahli Hospital had become a “glorified first-aid station,” he said, with only two functional operating rooms and more than 500 wounded patients. “What you ended up with was this huge number of patients with festering wounds—open, massive wounds that were eventually getting infected,” he said. He disinfected wounds of patients, including children, with a makeshift solution of laundry detergent and vinegar. “There was nothing else I could do other than try to do it very quickly,” he said, “while these children were screaming, just to stop them from becoming septic.”

Abu-Sittah also spoke about the specific kinds of wounds he witnessed in Gaza. He claimed to have seen burn wounds consistent with white phosphorus shelling, which he said he also saw during Israel’s 2008-2009 offensive in Gaza. (White phosphorus causes painful, potentially fatal burns and respiratory damage, and its deliberate use against civilians violates international humanitarian law.) Human Rights Watch and Amnesty International have also alleged that the Israeli Defense Forces have used artillery-fired white phosphorus in the current war. The Washington Post reported on December 11 that Israel used U.S.-supplied white phosphorus munitions in an October attack in Lebanon, which injured at least nine civilians. Israel has claimed that it uses white phosphorus only as a smokescreen and not to target civilians.

Beyond the wounds themselves, the blockade of Gaza has led to the deterioration of general health conditions, Abu-Sittah said. He saw wound patients “in a catabolic state worsened by malnutrition,” he said. “With malnutrition now prevalent, the newly wounded will fare even worse than the previously wounded, because they’re being wounded while malnourished.” Chronic noncommunicable diseases such as diabetes and asthma have turned fatal as supplies of insulin and inhalers run out. Overcrowding, unsafe water, and damaged sewage systems have led to the spread of infectious diseases such as hepatitis and respiratory tract infections. An Israeli airstrike killed Hammam Alloh, the last nephrologist in Gaza, in November. With each death like this, Abu-Sittah continued, the healthcare knowledge and specialization in the embattled enclave shrink.

Abu-Sittah emphasized the importance of “[stopping] the killing” and rebuilding Gaza’s public health infrastructure after the war’s end. “How do we approach complex clinical—and by clinical I mean both physical and mental health problems—that have happened on a public health epidemic scale?” he said. “How do you rehabilitate and find prosthetics for 1,000 to 1,500 children? How do you provide mental health treatment to two and a half million?” Such work will necessitate ending the siege of Gaza and allowing the entry of medical and other supplies, he said, so that the repair and resupply of hospitals can take place.

Another important step, Abu-Sittah said, is documenting the injuries and damage to healthcare infrastructure resulting from the war. “What has led us to the point where this is acceptable?” Abu-Sittah asked, pointing to the death and injury tolls. “This is beyond the question of Palestine. This is a global question. And documenting this is a critical component to forcing the world to come up with these answers.”

Read more articles by: Nina Pasquini

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