The
huge task of rebuilding parts of Gaza after the recent war with Israel
will be the focus of an international conference in Cairo this weekend.
The 50-day conflict caused massive damage and thousands of casualties,
overwhelming Gaza's hospitals.
The amateur video showed scenes of chaos - tens of doctors jostling from wounded to wounded; journalists with bulky TV cameras swarming around beds where dark red patches bloomed through patients' dressings.
Some casualties lay on plastic sheets on the floor, IV drips dangling above their heads.
"No hospital on earth is designed to cope with such a large and sudden influx of trauma like that. But if they had the procedures and protocol we have in London, they may be able to cope in such an emergency," Dr Simon said.
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The seasoned surgeons were shocked by
the footage of the emergency room of the Shifa Hospital - Gaza's busiest
- on 31 July, when more than 200 injured Palestinians were brought
through its doors.
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“Start Quote
Medicine is a global community, and it's a responsibility of ours to help our colleagues in need of assistance”
Dr Simon Calvert Consultant in major trauma
But neither Dr Naveen nor Dr Simon had ever been to the Middle East before, let alone a conflict zone.
"I'm terrified of leaving behind my wife and two small children. But I want to do something like this. Someone with the skills that I've been trained with, working in a state-of-the-art facility like King's, ought to be able to transfer these to a place that needs it like Gaza."
Dr Simon, who leads King's trauma unit, said that despite his nervousness about going to Gaza, he felt a duty to his colleagues in the hospitals in the Strip.
"Medicine is a global community, and it's a responsibility of ours to help our colleagues in need of assistance," he said simply.
Gaza City's Shejaiya district was badly
affected by the recent conflict, and many residents still choose to live
in the ruins rather than in crowded shelters
During the conflict many patients were
discharged prematurely to make room for new arrivals - but some did not
have a home to return to
The most common injuries sustained in the
conflict were trauma injuries resulting from shellfire or building
collapses, and burns caused by the heat of blasts
The Shifa Hospital in Gaza City is the largest, and yet it has only 583 beds.
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Shifa hospital, Gaza
28%
essential medicines have run out -
54% shortfall in medical basics such as gauze and breathing tubes
-
1,537 staff including 337 doctors and 495 nurses and midwives
-
583 total beds
-
11 intensive care beds
BBC
The human cost of the summer conflict
with Israel was brutal: 2,104 Palestinians were killed and more than
10,000 people were injured in the small territory, and the chronically
under-resourced Shifa was stretched to the brink in its response.
On the Israeli side, 67 soldiers and seven civilians were killed, with scores more wounded.
More than a month after the ceasefire, hundreds of Palestinians injured in the conflict are still struggling for their lives.
One of the most serious cases was that of Abdullah Abu
Harbeed, a 24-year-old man, newly married to a young woman called Iman.
Abdullah was injured in an air strike; most of the bones in his left arm
were shattered after building debris fell on him. As he was getting up
he fell on unexploded shell fragments.
Abdullah's leg had to be amputated after he lost half his pelvis and a large amount of his femur in an explosion
The second blast ripped out half his pelvis, removing a third
of his femur - the biggest, thickest bone in the body - and half his hip
bone. A huge semicircle of flesh was carved out from his side, and
nothing held his left leg to the rest of his body apart from mere inches
of flesh.
That happened four weeks before the arrival of the British
doctors. Confronted with such a complex case, their Palestinian
colleagues were stuck.
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Dr Naveen Cavale
Plastic reconstructive surgeon
“Start Quote
A wound this big is like having a
baby... So much blood and energy is diverted trying to heal it;
eventually your system wears out, organs fail and you will die”
Abdullah and his family were
desperate not to have his leg amputated, and the surgeons at Shifa were
unsure how to proceed in the face of stiff opposition from the patient.
By the time Dr Graeme Groom, the lead orthopaedic surgeon,
and the rest of the British team arrived to meet and inspect Abdullah,
flies were buzzing around the stained and dishevelled dressing.
His femoral artery, one of the largest arteries in the body, was visible, pulsing beneath barely a centimetre of tissue.
"If it were to break, there would be spurts of blood on the ceiling, and he would be dead in minutes," Dr Graeme said quietly.
In the operating theatre the doctors began cleaning up his
wound, and discussing what they could possibly do to help him. The
theatre was thick with the smell of rotting flesh.
"The trouble with a wound that big," Dr Naveen said, "is that it's basically like having a baby.
"So much blood and energy is diverted to the wound, feeding
it, trying to heal it, that eventually your system wears out, your
organs begin to fail and you will die. It's a miracle he's lasted this
long."
In the end, there was nothing for it but to remove Abdullah's
leg entirely from the top. Because there won't be any stump on which to
attach a prosthesis, he will have to spend the rest of his life in a
wheelchair.
The Palestinian Authority estimates that rebuilding Gaza will cost $4bn (£2.5bn) over the next three years
Day-after-day
The nature of working in emergency services in Gaza is unlike many other places.
As is often the case when war erupts - or re-erupts between
Israel and militants in Gaza - hospitals are stretched far beyond their
operational capacities in every aspect: working hours, available beds,
doctors and surgeons, medical supplies and hours of sleep.
Although there are 27 hospitals currently in service in Gaza,
the majority of these are small, with limited capacity. Only three
hospitals are able to manage major trauma - Shifa, and the Nasser and
European Gaza Hospitals in Khan Younis.
Ahmad, 13, suffered a fractured foot in an air strike, but only required a relatively simple operation
During periods of bombardment this summer, Palestinian doctors
worked for days on end. The threat of air strikes prevented many from
going home.
Dr Raed Nawas, a plastic and trauma surgeon spoke of the
never-ending torrent of injured people arriving at Shifa, and the days
and nights he worked without pause. He was not able to return home to
see his family for more than 30 days.
Doctors at Shifa spoke of some of the worst days, where
patients had to be operated on whilst lying on plastic sheets on the
floor, with surgeons crouching around them to the sound of falling
shells in the background.
Only three hospitals have the capacity to handle major trauma; one in Gaza City and two in Khan Younis
Medical supplies are often running low at Shifa hospital and often generators are the only power source
The British team found that while the standard of medical
practice by doctors in Gaza was very high, most surgeons were general
practitioners, and the Strip lacked the focus on specialisms intrinsic
to medicine in the West.
Unlike the surgeons of King's, surgeons in Gaza begin work far earlier after finishing higher education.
Expense, lack of funding and imminent need for practising
doctors means the surgeons of Gaza miss out on years of dedicated focus
on training and research.
Khalil, 27, will need to have his foot amputated after losing his heel bone in an explosion
The nature of injuries that most often occur in Gaza during
conflict with Israel are very traumatic wounds typical of wars, from
lacerations resulting from shellfire to traumatic injuries caused by
building collapses. The injuries also cut across a whole range of age
groups, from children to the elderly.
More than half of Gaza's population is under the age of 18,
according to the World Health Organisation (WHO), and yet there is not
an adequate number of doctors specialising in paediatrics.
However, as talks between Israelis and Palestinians to shore
up the truce agreed in August continue in Cairo, there is a chance for
medics to focus on the long-term needs of their patients in the absence
of war. The fighting may have stopped for now, but for some injured
Palestinians the battle for their lives continues.