Gaza’s hospital crisis shows the difficulties of providing health care in times of war

The Gaza Strip’s medical system is on the verge of collapse after bombings damaged hospitals and ambulances. Generators are running out of fuel, highlighting how quality health care can become a casualty of war.

A dire scenario awaits medical professionals in Gaza. Faced with dwindling basic resources such as electricity, water and anesthesia, doctors are forced to make difficult decisions about whose lives to save. Escalating humanitarian crises are forcing health workers into critical emergency planning for both man-made and natural disasters, assessing staffing and other resources to address new and dire needs as well as existing medical needs. need to be managed and concerned about their own welfare.

“When we face a disaster or conflict, there are usually more patients than resources. We have to be very creative to provide the best care to the most people,” Boston said. said Lindsay Ryan Martin, director of global disaster response and humanitarian operations at Massachusetts General Hospital, who is monitoring the situation in Boston. Gaza.

The medical crisis extends beyond Tuesday’s deadly explosion at Gaza City’s al-Ahli hospital. Aid groups say the war continues to put an already strained health system at risk.

Everything we know about the hospital strike in Gaza

The Gaza Ministry of Health announced that five hospitals were closed as of Thursday. A further 14 medical facilities were closed due to lack of fuel and electricity.

After Hamas militants launched an unprecedented cross-border attack on Israel on October 7, Israel has put the Gaza Strip under “total siege,” cutting off power, food and fuel, and restricting access to medical supplies and cross-border travel for high-risk diagnostics and surgeries.

Assessing and verifying medical realities on the ground in Gaza has been difficult due to difficult communication with medical experts and limited access for journalists.

U.N. aid chief Martin Griffiths told The Washington Post on Wednesday that the hospital explosion had worsened Gaza’s humanitarian crisis, forcing the hospital, which treated 45,000 patients a year, to close. .

“Health care workers, why are they staying?” Griffiths said. “And how can we move the sick people coming out of the hospitals in Gaza City, which we have already been talking about in the last few days? How can we move them who are in intensive care? ?”

After the explosion in al-Ahly, Palestinian health authorities said nearby al-Shifa was being flooded with patients., Gaza City’s main hospital was beyond the capacity of medical teams and ambulances. They said doctors were relying on treating injured patients on hospital floors, some without anesthesia.

An anesthesiologist at Al Shifa told the Post that attempts to save people had failed and bodies were left in the hallway. He shared a video he shot showing a chaotic scene, including a patient being treated on a teal floor and a man pleading with others to remove the body so he could bring in another patient. .

The hospital official, who spoke on condition of anonymity because he was not authorized to comment to reporters, said he was concerned about an increase in infections due to a lack of clean water and electricity to desalinate water. He has already seen an increase in infections, diarrhea and fever, and worries that children will become more dehydrated.

The hospital worker said the last time he slept properly was on October 5, before the conflict began, but he did not know if his home was still standing. “That was the last time I saw his wife and children,” he said.

A Gaza hospital that provided a much-anticipated rest is now a scene of mourning and questions.

Erica L. Nelson, who has worked in humanitarian medicine for about 25 years, says Palestinian doctors in Al Shifa who are part of her WhatsApp group are increasingly afraid of being targeted. Told. “The addition of ‘we are at risk’ changed the tone of the conversation,” said Nelson, an emergency physician at Brigham and Women’s Hospital in Boston.

In recent days, international aid groups have revealed further evidence of Gaza’s shattered health system.

The World Health Organization (WHO) said there was a shortage of medicines for hundreds of thousands of patients. Médecins Sans Frontières, which has staff on the ground in Gaza, said the airstrikes have made it “extremely dangerous” to run ambulances and transport patients to medical facilities. The United Nations Palestine Refugee Agency, known as UNRWA, announced on Wednesday: Fewer than half of health centers can provide basic care to patients. All three organizations confirmed the reports of survival. In danger as a generator Run Out of fuel.

The WHO has called on Israel to allow fuel shipments as part of a deal brokered to allow humanitarian aid to Gaza.

“If we run out of fuel, we may be working with flashlights, we may be caring for people with medicines that don’t require refrigeration, and of course we may not have access to testing services.” said John Broch, director of emergency medical services and disaster management at the University of Massachusetts.monument Located in Worcester, Massachusetts

Mr Broch said the struggle to care for patients injured in war or disaster was exacerbated by factors such as: escalation Cases where routine medical problems are suddenly left untreated, such as patients with diabetes who are currently well-managed. If a refrigerator loses power, spoiled insulin cannot be taken, and chronically ill patients are unable to fill prescriptions in shuttered pharmacies.

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David Carraway, Chief Veterans-Led Health Officer Team Rubicon is a nonprofit organization based in Los Angeles. He said the organization works closely with the WHO to provide relief in humanitarian crises, but that disasters can have dangerous consequences for health workers who work tirelessly with limited resources.

“Quickly, the entire team becomes burnt out, lacks empathy, and is unable to make the best decisions.” Said Carraway served as a battalion surgeon during the Iraq War and recently oversaw his organization’s humanitarian efforts in Ukraine.

The decisions healthcare workers face during disasters are important. While healthcare workers are focused on the patients in front of them, they are keenly aware of the enormous needs elsewhere. “I feel like I have to set different values ​​for different lives based on what I’m seeing in that moment,” Calloway said. “Is a child’s life more valuable than an old man’s life?”

Thomas Kirsch, an emergency physician at George Washington University Hospital and an early practitioner of disaster medicine, recalls the moral crisis that arose while working with a Johns Hopkins team in Haiti after the 2010 earthquake. I remembered the dilemma.

There simply weren’t the resources in place to treat everyone in need, he said. “You’re putting yourself in a situation where you’re not doing what’s best for the patient, and you can potentially harm or kill the patient,” Kirsch said.

He said such decisions are best taken out of the hands of care providers by establishing ethics counselors or ethics committees.

At the same time, disasters require healthcare providers to come up with systematic ways to coordinate the care they can provide. “Can you scrub without soap?” Do you reuse sterile drapes? Do you boil water on the stove? ” Kirsch said.

Families in Gaza face tough choices as they seek safety

Some superficial surgeries can be performed without anesthesia and conjure images of Civil War-era surgeries, Kirsch said. “But you can’t operate on the heart, lungs or abdomen,” he said.

Paul Spiegel, director of the Center for Humanitarian Health at the Johns Hopkins Bloomberg School of Public Health, said doctors in conflict zones are working in ways for which they are not trained. As a young general practitioner treating patients with severe amputations during the Rwandan genocide, Spiegel, despite having no professional training, followed instructions as best he could, treating severed fingers and other severe wounds. He said he had dealt with it. “We have no choice,” he said. “I tell myself I can probably do it better than the amateurs.”

The healthcare system in Gaza, which has been under Israeli blockade for 16 years, was already in trouble before the war. The Israel Civil Affairs Authority controls the entry and exit of all patients and goods, which can limit medical care. The recent attacks that damaged medical infrastructure are reminiscent of the 2014 conflict in Gaza, when 24 medical facilities were damaged and more than 15 medical workers were killed during 50 days of Israeli attacks.

Experts say the war has left medical care at a time when authorities face the difficult task of rebuilding facilities and rebuilding the trust of patients who fear seeking treatment after healing sites turn into danger zones. He said it has left a lasting mark on the system.

“For months and years to come, the region will still have a collapsed health care system,” said Rohini Har, a medical consultant at Physicians for Human Rights, who has studied the impact of war on health care systems. . “People in the communities that were attacked will be living with this attack for years to come.”

Dadush reported from Beirut. Claire Parker in Cairo, Kyle Lempfer in Washington, Louisa Laraque in London and Miriam Berger in Jerusalem contributed to this report.

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