An attack led by the extremist group Hamas thrust Americans face to face with events unfolding in Gaza and Israel in early October.
But few have had Gaza materialize before their eyes like two Toledo-area anesthesiologists on separate recent medical missions to help the wounded and dying near Khan Yunis, at the European Hospital in the south of the Gaza Strip.
“I just felt that those people are suffering a lot,” said Dr. Abdalrahman Algendy, the most recent anesthesiologist back from the medical mission with the Palestinian American Medical Association.
“I know, it's a minor, very minor thing to do, is just to go and even help them get anesthesia, for when they're getting their limbs cut.”
And their skills were needed: Procedures performed without anesthesia can be both painful and life threatening.
“The human response, the sympathetic response to having an incision, to having surgical pain without anesthesia is extreme hypertension, extreme tachycardia, meaning that the heart rate goes up really fast. And it puts people at risk of strokes, at risk of heart attacks and at risk of dying of the surgery itself rather than the injury,” said Dr. Ndal Farah of Sylvania Township, who traveled into Gaza from Feb. 8-20 with Rahma Worldwide.
“So as an anesthesiologist, you put people to sleep for surgery, and then the main job is actually keeping them safe during surgery.”
Toledoan Dr. Fadi Safi, who is on the board of PAMA, said his group is one of three organizations currently sending doctors from the United States to Gaza. The others are Rahma Worldwide, just outside of Detroit, and MedGlobal, outside of Chicago. Since Oct. 7, he estimated between just 80 to 90 individuals had been sent to Gaza.
“The doctors are being allowed and because the [World Health Organization] asked for that, and because the doctors themselves want to go,” Dr. Safi said. “Each doctor takes his own food and water with him and and the medical supplies he’s going to use, take it in a bag. And they've been allowing some of those, like especially the local anesthetics, antibiotics, and the minor surgical equipments to get in.”
Both local doctors had to bring their own supplies into Gaza on their backs.
“Myself I had six bags, so one personal [bag] and then two medical equipment [bags], and three bags of medications,” Dr. Algendy said.
Security briefings from the World Health Organization and the United Nations — along with long lines of aid vehicles waiting for permission to get in — preceded the groups entering Gaza. Dr. Algendy, of Ottawa Hills, who was on the ground from Feb. 19 to March 4, was admitted after checks from Egyptian border guards lasting about three hours.
Dr. Farah’s team of 19 doctors with Rahma Worldwide was not as lucky, and they were stymied at the border.
“It was a long day of waiting. We lost a whole day of our mission trip, just waiting at checkpoints,” he said.
It then took about 20 minutes to get to the European Hospital. The doctors described a building set up for about 250 hospital beds.
“The area of the European Hospital has been kept safe for these, for these groups of doctors,” Dr. Safi said and added that there were two other hospitals that were also fully functional in Gaza. Other hospitals already raided by Israeli forces now functioned in a limited capacity, as something akin to an urgent care, he said.
“A lot of patients who went in and received medical treatment refused to leave because they had no other place to go,” Dr. Algendy said. An estimated 30,000 to 40,000 people were set up in and around the hospital, because they hoped one of the last fully functioning medical centers in Gaza would provide some form of safety for them.
“All the hospital corridors are filled with people lying on the floor. People use bedsheets or plastic sheets and then drop them from the ceiling and would tie strings to make [a] kind of privacy for themselves. Like the whole hospital, every hospital door, is filled with these type of situations.”
And the same materials were cobbled together into tents surrounding the building.
“They have more than 60,000 fully injured people,” Dr. Safi said of the injured in Gaza.
Dr. Farah used the word surreal to describe the situation.
“On the one hand you could walk one way and you could see like body bags, and you could walk another way and see kids playing soccer,” Dr. Farah said.
Both doctors traded human comfort for two weeks of sleeping just 90 minutes to five hours a night, with five to seven people per room, one meal a day because of food scarcity, and working with a constant influx of patients.
“All of the patients were very thin,” Dr. Algendy said.
Dr. Algendy’s first patient in Gaza set the tone for the rest of his time there.
“We found this young, young man who, his body [was] mostly burned, his both lower limbs were crushed. One side was dangling with just skin, the other side was like crushed, broken. So he had to receive bilateral lower limb amputation, and then kind of debridement (cleaning of tissue) of the severe burns all over his body,” he said.
“That was the very first patient,” he said. “And then consistently patients injured in a similar fashion, number of amputations were significantly high, I mean, I cannot count how many amputations with just patients coming in after a blast injury, legs are dangling. Either they receive one side amputation or maybe both sides and then maybe a fractured upper limb.”
Eye and face operations were also common for Dr. Algendy.
“Another patient, who was under the rubble for maybe seven to eight days, came to us with a split face — both his eyes were gone,” Dr. Algendy said. “His face was literally from you know, lips, nose, and forehead, split into half. The amazing thing was that he was still talking when he came into the hospital.”
Dr. Algendy said severe blasts resulting in amputation or face procedures shocked him the most. As Egyptian-American, he previously worked in Jordan and Tanzania, but never in a war zone before.
Dr. Farah, who was there two weeks before Dr. Algendy, said he was more shocked by the demographics of the patients he was treating.
“The patient makeup was by far, mostly pediatric, was mostly children. There were injuries that you see consistent with what you see in the news. There’s crushed injuries, there’s burn injuries, but then you also had like 6 year olds that were shot in the head,” Dr. Farah said.
“You had pregnant women that their legs were mangled. It's unlike a lot of other war scenes in that the typical warrior, the young male, was the exception to the patients’ load not, not the rule. Mostly it was women and children that I treated.”
Dr. Farah, a Palestinian-American, had never traveled to Gaza before, but he has worked in war zones, most notably inside Syria.
“I went to Syria. It's not because I'm Syrian, and I'm not, it's because I'm a human being,” he said.
“I would relish the chance to go to Ukraine or to help the Rohingya in Bangladesh or anything,” he said. “I think I'd like to make medical missions part of my career.”
His other notable medical missions included going to the Dominican Republic, Turkey, China, and Jordan, with Syria and Palestine marking his trips to active war zones.
But his experience in Gaza, he said, was unlike his previous experience with war.
“By far Gaza is exponentially worse than anything I've ever seen. Just the volume of the injured, the demographic makeup of the injured,” he said.
On average, Dr. Farah was seeing about 20 patients a day, maybe more or less, but he was psychologically upset by the high number of children. The majority of ICU patients he saw at that time were children.
“So even if it was indiscriminate bombing it's gonna be 50 percent children,” he said, because Gaza is half children. “But then I think there is an intentional aspect to this where like, the wounds, the injuries that I saw on these children was consistent with intention.”
“Just look at the size of a bullet and the size of a kid’s head, and they're making contact repeatedly,” Dr. Farah said. “It's hardly just chance. I'm not a forensic expert, but I do have some basic common sense.”
Throughout the day and the night, both doctors said they heard the constant whirring of drones overhead, alluding to constant surveillance, with intermittent bombing throughout the day and then continuous bombing at night.
Neither doctor said he saw Israeli troops or anything more than drones or planes during their collective month in Gaza. Likewise, neither doctor saw any sign of Hamas or any militant individual.
Patients would come in and give reports of what happened to them, without the doctors able to confirm it, except in one case.
“So I watched it on Al Jazeera,” Dr. Farah said. “It was weird, because I watched the reporter. ... He’s out in the field reporting, and then he's like, looking over in the sky and looking over his shoulder because there's a drone. And he's, like, suspicious of it. And then, a little bit later, they arrived as our patients.”
The two journalists Dr. Farah treated were Al Jazeera’s Ismail Abu Omar and Ahmad Matar.
“It was a reporter and a cameraman. They came in on same day. The reporter was in a different operating room getting his leg amputated.”
“The cameraman was in a lot worse shape,” Dr. Farah said. “And he ended up with a craniotomy, so he had a bleed on the outside of his brain. And then, while the neurosurgeon was working on his brain, we had an orthopedic surgeon working on his foot. And he actually arrested, like, he had cardiac arrest during the surgery.”
Luckily, the doctors were able to stabilize both individuals, but Dr. Farah was unsure of any neurological damage to the cameraman.
“Yeah the war needs to end five months ago,” Dr. Algendy said. “And unfortunately, it's going to take a very, very long time for this health care system to stand back on its foot and get back to maybe pre-war times.”
When he came back to the United States, Dr. Algendy wondered why and how the locations he served in were kept safe, and Dr. Safi had his own answers to the questions.
“I'm a humanitarian, as you know, and a physician. So I don't know about anything about the political situation over there,” Dr. Safi said.
“Under international law, you have to keep some medical facilities functional, and I think that's what they are doing,” he said, adding that he is unsure how two of the three functioning hospitals in southern Gaza will remain operational.
Dr. Farah and Dr. Algendy, who are both 42, said they were happy for the time and effort spent in Gaza and that they would return to help.
“I never regret it,” Dr. Algendy said. “The people are in a very bad situation, but they're still smiling, they’re still patient, and they're very thankful that we left our homes, from safety — came to a war zone and wanted to help them.”
One individual thanked Dr. Algendy for allowing her to sleep for the first time in weeks.
“We gave her nerve blocks prior to her surgeries ... prior to that she used to scream from pain,” he said. The woman in her late 20s to early 30s required multiple operations. Cases like these convinced Dr. Algendy he had made a difference in spite of the overwhelming conditions.
“Of course, there was trepidation coming into a place that's being actively bombed,” Dr. Farah said. “But that was secondary to the mission.”
First Published March 17, 2024, 11:30 a.m.
