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Health system in the Gaza Strip: “Then a bullet went through the intensive care unit”

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Health system in the Gaza Strip: “Then a bullet went through the intensive care unit”

Seema Jilani leads emergency medical operations for the humanitarian aid organization International Rescue Committee (IRC). At the beginning of the year, the pediatrician herself was working in the emergency room of Al-Aqsa Hospital in the central Gaza Strip. Because of the bombing, the IRC team had to be evacuated after two weeks. In the following interview she describes drastic scenes that can be very disturbing.

TIME ONLINE: Ms. Jilani, whose idea was it for you to go to Gaza?

Seema Jilani: I volunteered. Initially, I was involved in the planning of our operation as a senior consultant for emergency medicine. Since the Gaza Strip has been so insecure since the outbreak of war, careful planning and a concept were important. It was my suggestion that I would also be there as a doctor. Over the past 19 years, I have repeatedly been to war and crisis areas, including the West Bank and twice to Gaza. So I’m used to a lot.

American pediatrician Seema Jilani leads emergency medical operations for the humanitarian aid organization International Rescue Committee (IRC). Among other things, she also trains other doctors to represent their patients’ concerns in the media. © Sami Thabet for MAP (Medical Aid for Palestinians)

TIME ONLINE: When you think about your first day at Al-Aqsa Hospital, what do you remember?

Jilani: In the first few hours I treated a one-year-old boy. A bomb had blown off his right arm and leg. He still had his diaper on, it was full of blood. I had to treat him on the floor, there were no stretchers. Next to him lay a man who had been dying for around 24 hours and was struggling with death in his last breaths. There were flies all over him. Then a woman was brought in and immediately pronounced dead. Meanwhile, my one-year-old patient was bleeding into the chest cavity and needed a drainage. However, there were neither suitable drainage tubes nor child-sized blood pressure cuffs. We barely had morphine to stop his pain. In the USA, this boy would have been taken to the operating room immediately. Instead, the trauma surgeon came, bandaged the boy’s stumps and said that there were more urgent emergencies in the operating room. I wondered, trying to imagine what could be more urgent. This is an example of the impossible decisions that doctors in Gaza are forced to make. The situation is catastrophic.

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TIME ONLINE: How does triage work with children in a place like this?

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Jilani: I don’t believe any hospital system in the world, no matter how sophisticated, could withstand one mass emergency after another. In addition, doctors and health workers have been forced from their homes by the destruction, and many of them have even lost their accommodation several times. They continued to care for their patients even as they searched for shelter, food and water for their families. They still showed up in the morning with their stethoscopes and worked through their shifts. Many of them didn’t even get any money for it. They often had to declare friends and family members dead overnight and then continued to treat patients. They only took a break to cry briefly or to say a prayer to the dead if time permitted. You have shown a colossal level of bravery. I drew my strength from that.

TIME ONLINE: How did you communicate with your patients and the team?

Jilani: The aid organization Medical Aid for Palestinians supported us greatly in this mission. They provided us with local employees who also interpreted for us. The entire operation would not have been possible without this help.

TIME ONLINE: What questions did you typically ask the team or relatives?

Jilani: As a pediatrician, I have two main questions when I work in crisis areas. The first is always: Have we already given the patient a painkiller? And the second is: Have we informed the families? Because these are the two things that often fall by the wayside because everyone is too busy with the things that are important for survival, like ensuring breathing or stopping bleeding. But these two questions are very important for patients and relatives.

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TIME ONLINE: As a pediatrician, it is also important to be able to tell a story. To distract the children or explain something to the parents. Were there moments when you were still able to do that in Gaza?

Jilani: I tried to create these moments. Efforts have to be made because the extent of the injuries to these children, whether they arrive in an ambulance or a donkey, is enormous. If there is fuel, the injured may be brought in by car, while other children may be carried in on a mattress by their parents. It’s extremely chaotic. There was once a seven-year-old boy. His injuries were not life-threatening, but he had sustained deep lacerations from a bomb attack. We gave him as much painkiller as we had available, but it wasn’t enough. I tried to distract him a little. I showed him a small flashlight that illuminates various lights on the wall. He wasn’t interested. Then I wanted to ask him questions. This usually distracts a child enough to tolerate the pain. But every single question I could think of was like a landmine for the children in Gaza. I couldn’t ask “Who is your best friend?” because it could have been that her best friend had died in a bombing. Otherwise I also like to ask: What is your favorite food? But in Gaza, I didn’t know when the children had last eaten. I thought, what question can I ask without traumatizing the child? Normally I also like to ask about the parents – but perhaps the child was already an orphan. This boy was there with his uncle, so it was quite possible. The fact that there was ultimately no innocuous question shows that every single area of ​​life of the people in Gaza, their entire society, was completely destroyed.

TIME ONLINE: What impressions did you have when you left Gaza?

Jilani: The military attacks became quite intense during my last day at Al-Aqsa Hospital. I remember breastfeeding mothers whom I was advising in the children’s ward when suddenly clouds of smoke began to rise and bombs were getting closer and closer. Then a bullet went through the intensive care unit. And the next day the road to the hospital was deemed unsafe so we could no longer use it. Then the Israeli military dropped leaflets designating the areas around the hospital as a red zone. People in the area around the hospital were evacuated. Our team couldn’t go back there.

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TIME ONLINE: Are you still in contact with any of your Palestinian colleagues from Gaza?

Jilani: Yes. But many of the doctors I’m in contact with have been displaced again. And Al-Aqsa Hospital eventually ran out of fuel and could not continue operations. When I heard about it, I kept thinking about the children, the babies in the incubator in the NICU, the children with burns who weren’t well enough to be transported or walk. Those who couldn’t be evacuated.

TIME ONLINE: They talk to the media more often about the situation in the Gaza Strip. How does it feel for you to keep reporting on your impressions?

Jilani: I am a doctor and have been for almost 20 years. If doctors weren’t able to carry on, if we cried and broke down whether we were in a war zone or not, we wouldn’t be able to do our jobs. I worked in pediatric palliative care for years. So children are cared for at the end of their lives. I have conducted medical evacuations for seriously ill children and I have witnessed severe child abuse, to the extent that children would have seizures and die. And all of this happened in the USA. Of course, these are less extreme conditions, but you don’t need a war zone to experience such tragedies. I believe this is a mechanism that we physicians have to serve our patients.

TIME ONLINE: After seeing so much suffering, do you still get angry? And if so, to whom?

Jilani: I think there are a variety of emotions that I feel and I still have a hard time filtering them out. I’m most likely to be angry at the existing systems and the people who are in power. Those who allow this humanitarian catastrophe to continue for so long and who do not speak out about the suffering of the families and this generation of orphans. I’m angry about that. That the international community is failing in its humanity.

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