“We are being exterminated on TV,” messaged our Gazan colleague, Dr Khamis Elessi, via WhatsApp.
Gaza is facing an apocalyptic disaster that seems inconceivable from the safe distance of our loungerooms around the world. The healthcare system has reached an unparalleled point of devastation owing to the number of injuries and people needing urgent healthcare, combined with severe shortages of beds, essential medicines, electricity, and water. Doctors are running out of life-saving equipment.
“Never in Oxfam’s history have we seen a humanitarian crisis like the one in Gaza,” headlined an article in The Guardian last week by Oxfam GB’s CEO, with the story stating: “The humanitarian rulebook has been thrown out.”
Dr Hammam Alloh, our co-author, is a nephrologist (kidney specialist) working in the largest hospital in Gaza City, Al-Shifa. His phone has an internet connection that lasts only about 29 minutes per day, so he sends a voice message via WhatsApp for efficiency:
A very sad story that I do not want to even remember, but I feel obliged to mention, is what happened yesterday at work. I had to stop resuscitation to a dialysis patient who had a cardiac arrest. The reason I had to stop resuscitation is that I couldn’t offer her a ventilator if she even made it after the resuscitation.
But Dr Hammam knows that even the life-saving equipment that is available will soon have little use if Gaza does not receive an urgent supply of fuel for electricity. Fuel, needed to run backup hospital generators, remains banned by the Israeli authorities. At any moment now, perhaps even as we write, hospital electricity supplies are going to run out completely. No electricity means a system collapse of catastrophic proportions for those dependent on machines — ventilators for artificial respiration and dialysis machines to treat kidney failure — to sustain their lives.
There are dozens of babies, children and adults being kept alive by ventilators across Gaza. In Gaza’s neonatal intensive care units, there are 130 fragile newborns weighing less than one kilogram in incubators reliant on electricity. If there is a power outage, all those connected to artificial respiration will face certain death within minutes. They will not be able to breathe without oxygen. They will suffocate. There will be no protection any healthcare worker can offer even for the sickest babies whose lives they could have saved with a steady supply of fuel and water.
Dr Reda Abuassi, the head of the paediatric intensive care unit at Nasser Hospital and a mother to five children, messages, “We are suffering and we don’t know how long we can last”. Reda has had to evacuate to the south of Gaza in the hope of finding safety for her family, making the heartbreaking decision to leave her seriously unwell child patients behind in the care of her colleagues.
There are over 1,100 people with kidney failure in Gaza who need regular haemodialysis. Even before the current war, people with renal disease were deprived of many of the medicines, laboratory testing, and diagnostic biopsy facilities needed to offer a basic renal service. The number dependent on dialysis is increasing rapidly as a result of war injuries. The renal service at Al-Shifa Hospital has had to cut haemodialysis sessions from the required four hours to two hours to cope with overwhelming demand.
Dr Hammam is frightened about the imminent power and water outage, which means a complete shutdown of dialysis machines: “If this goes on for more than a few days, this will mean imminent death to those dependent on haemodialysis.” The deaths will also be severely painful in the absence of any available pain and symptom relief.
Many of us who sit in countries with functioning healthcare systems will have witnessed the fragility and precariousness of life held together by a machine. Many would know the rigid and regular timetabling of haemodialysis treatment that is necessary to preserve life. Some of us may have had the worrying experience of watching our baby in an incubator crib, praying every moment their little innocent bodies will grow enough in strength for us to bring them home. Others may have had to walk the journey of profound grief that comes when a ventilator is no longer sustaining life and we allow a loved one to slip away.
What Gaza is experiencing is beyond all our deepest grief and imagination.
Dr Hammam speaks of his unbearable pain in not being able to help his dying dialysis patient:
I know in many other parts of the world, this means I literally killed her. But I had no better choice, other than what I did. If you could imagine the amount of pain, the amount of regret I am living with after this happened, I have no words to describe that. But I had no other choices.
Gazans are readying themselves for these wicked choices and deaths on an unfathomable scale, a foreboding that is the cruellest of realities. The strength of community and instinctive compassion in Gaza will mean no adult, child or baby dependent on life-saving machines dies alone if the power snaps shut. Every newborn will be cuddled with love as they take their last gasp. But this is a post-apocalyptic image too much to bear on our collective conscience, when we know the world could have stopped it.
A family doctor colleague messages today, “The worst thing that could happen to us is that the world becomes indifferent to the scene of our death and annihilation”.
Gaza needs an immediate ceasefire and actions to ensure constant supply of fuel, water and medicines. We cannot afford to turn off our TVs and look away.
