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War Surgery Is Not Peace Surgery: An American Doctor in Gaza

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Injured girl in Gaza
At the Gaza European Hospital’s emergency room, in Khan Younis: a three-year-old with shrapnel injury to her right foot and second-degree burns to the knee, is treated from an explosion. Dr. Feroze Sidhwa, a trauma surgeon from California, spent several weeks volunteering in the hospital, relaying his experience by text and voice messages to the writer, another American doctor. “Today was the first day that we felt blasts that actually shook the hospital,” he wrote. “I haven’t been able to read the news here because the internet connection is terrible. But I’m guessing the Israeli fronts getting closer? But I have no idea.”

Dr. Feroze Sidhwa is a 42-year-old critical care and trauma surgeon based at San Joaquin General Hospital, a level-two trauma center, in San Joaquin County, California. He arrived in southern Gaza in March, carrying thousands of rolls of paper tape, Kerlix bandage wraps and medicated Xeroform gauze: tools of his trade. What bullets and shrapnel had vaporized in Gaza, Dr. Sidhwa would do his very best with a scalpel and medicated cotton to save what was left behind.

From California to Cairo and an eight-hour bus trip across the Sinai with Palestinian American Medical Association (PAMA) colleagues, Dr. Sidhwa and the others arrived at the Rafah border crossing, where they entered Gaza on March 25. It was dark, after sundown, and unexpectedly quiet.

His first sight of Gaza European Hospital, in Khan Younis, was an outdoor square, called the Medan, a five-minute walk from the main hospital entrance. He would share a room, a converted Covid-isolation space, near the Medan with six other men. (Editor’s note: The third photo of a patient, by Dr. Sidhwa, is very graphic.)

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The room was “filthy and fly infested,” as he later described his place to sleep and where he would gauge the advancing proximity of the Israel Defense Forces’ bombardments. As he exited the van at the Medan, it was the children, short and malnourished, who greeted him first. “Hallooo!” they cried, asking for sweets and chocolate. The courtyard was their living room.

Dr. Sidhwa was interviewed during his stay at the hospital, for about two weeks in March, and afterward by phone and email. Additionally, he sent written and audio text messages to me, detailing the situation regularly from Gaza, and this article is composed of all these communications. We met as graduate students in global health and international humanitarian law at the Harvard T. H. Chan School of Public Health in 2009, and we agreed that I would write this story before he went to Gaza. (On May 18, some foreign doctors volunteering at the hospital were evacuated from Gaza after being stuck there when Israel invaded Rafah, the southernmost city in the enclave, this month.)

For Dr. Sidhwa and his group, hospital orientation began in the four intensive-care units: one postoperative; one cardiac, although, without elective heart surgeries, this “cardiac” was in name only; one pediatric; and a repurposed endoscopy space, for a total of 24 intensive care beds.

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Scanning the beds and the CT images, Dr. Sidhwa quickly realized there were three tracks of ICU patients. First, the “bullet wound” patients, most often to the head, who were often intubated and unresponsive. Second, the “post-explosive” patients, with exposed and broken bones and external rods poking out from under the sheets. Third were the “DKA” patients, Type 1 diabetics in coma-hovering states. In wartime, the Gaza European Hospital was filled with civilian post-explosive trauma patients and insulin-dependent diabetics.

The DKA patients were unexpected. To survive, they require regular insulin, and insulin requires refrigeration. In Gaza, with over 1.7 million people displaced, “There’s no outpatient insulin, because nobody has a house anymore; they can’t refrigerate anything,” Dr. Sidhwa told me. In Gaza, diabetics have become sentinel patients, the “canaries of the coal mine,” he added, and a visible reminder of the critical failures amid this unrelenting humanitarian disaster.”

Dr. Sidhwa got to work right away and messaged me by WhatsApp his progress on March 26, writing: “Did four ex laps today [an exploratory laparotomy: opening a belly to see if there is injury inside], all in children. All from explosive weapons. One also got a crani [craniotomy: an operation to remove skull bone to see if there is injury inside] and one got an ex-fix [an external fixator: metal rods fixed on the outside of the body to hold broken bones in place]. All of them were wounded hours before arrival since they had to be extracted from rubble.”

The Gaza European Hospital was founded by the United Nations Relief and Works Agency for Palestine Refugees in the Near East (UNRWA) in 1989, and it is estimated to have 200 beds and more than 500 staff. The numbers were hard to verify for Dr. Sidhwa, but what he did know was that patient numbers had exploded, while medical, nursing and staff resources had been eaten up, systems were nonexistent and what little untrained staff remained were exhausted.

A tent city had sprung up around the hospital, without the water, facilities or shelter to support such a displaced-persons camp. In a WhatsApp voice message, Dr. Sidhwa described the scene on one of his many walks to and from the Medan: “It’s just squalor everywhere. Everything is disgusting. Tents on both sides, densely lined, 7, 8, 9, 10, people living in each one. Some of them are made out of tarp. Some of them are actual camping tents. A lot of them have, you know, a lot of those are sewn together from sacks of flour.”

He added: “I’m walking by the four latrines that people share here. I’m told there’s 20,000 people on this, on the hospital grounds. And they share four latrines. You can imagine the smell. And it’s literally right in front of the hospital main entrance, which is also a giant tent city.”

Medical Team in Cairo before heading to Gaza
Dr. Sidhwa, far left, and his group from the Palestinian American Medical Association, outside the Meridian Hotel in Cairo before heading to the Rafah crossing to enter Gaza, March 2024.

Dr. Sidhwa saw that the tents were numbered, saying: “I hadn’t noticed it before, but every tent actually has a number and a designation on it. There was a WhatsApp tracking system to see who needed food, and who was disabled, so that they would not be forgotten.”

Despite the many displacements and trauma, people around the hospital wanted to stay together as families. That preference was exposed in the emergency room mass casualty events every night. Amid ongoing bombardments and explosions, whole families were killed or injured together.

One week in, on March 31, Dr. Sidhwa sent a WhatsApp voice message from Gaza after experiencing one such night on call: “Last night we had another mass casualty event. This time literally 100 percent of the patients were women and children. There was a mom who just had some minor wounds. Thankfully, she was fine. Her son was on the bed with her, three years old. He ended up having blood around his lung, from a shrapnel injury that had to be drained. He had shrapnel injury to the head as well. Hopefully, will not be too bad as long as his brain doesn’t swell badly, he should do O.K with it.”

His mother “had to watch blood pour out of her child’s chest and was completely stoic about it, totally nuts,” Dr. Sidhwa said, adding, “She stroked his hair as we put in the tube.”

He described another child: “And, then there was another young girl, probably six or seven years old. I think she was that mother’s other child. She had a bunch of lacerations, really, all over her body. But thankfully, nothing life threatening. She’ll have to deal with wound infection and stuff like that for a while.”

This tidal back-and-forth description, between near death and hope, was a signature imprint from Dr. Sidhwa’s WhatsApp text and voice communications.

“Sorry, I’m walking through the hallways,” he said, in another voice message, “probably can hear, there’s people everywhere here. It’s impossible to find a quiet place in Gaza right now.”

While the hospital’s ICUs filled with head injuries, long-bone fractures and patients in DKA, the wards filled with the civilian war wounded.

Dr. Sidhwa walked the wards and was met with cries of, “Doctor!” and, with quick bedside consults, determined that all the patients needed surgical repair. “Every time you go [onto the ward], you walk around and people just come up to you and say: ‘Doctor, doctor, doctor, look at this. Look at this! Look at this! Look at this!’ And, I mean, literally every single time, it’s like, oh, that needs surgery, that needs surgery, and that needs surgery too,” he said.

Despite building collapses, there were few crush-injury patients in the emergency room trauma bay because the crushed didn’t make it in. The most common living-injured patients had post-explosive extremity injuries; arms missing here and legs missing there. Most of Dr. Sidhwa’s trauma patients were women and children.

The emergency room remained a steady stream of human trauma, day after day, night after night, during Dr. Sidhwa’s stay. An early post-call voice message was sent to me on March 29:

“Had a big mass casualty event last night, apparently a building with a hundred people in it was destroyed. Had a seven-year-old girl with a blast wave injury that gave her a right pneumo [pneumothorax: collapsed lung] and a bad left pulm [pulmonary: lung] contusion [contusion: bleeding and bruising]; she’ll live if we don’t have any delayed-presentation abdominal injuries, but they often do. Her twin sister was buried under the rubble right next to her but was thankfully fine other than cuts and bruises. Her sister had a right hemopneumo [hemopneumothorax: bleeding and collapsed lung] and a depressed [pushing down on the brain] skull fracture with a bad TBI [traumatic brain injury]; had to be intubated, but if she doesn’t have DAI [diffuse axonal injury, serious neurological injury] she should recover. Had several depressed open skull fractures, most with small associated bleeds and most of them were actually awake and talking. Two children arrived dead, they both looked less than 2 years old, and an old woman died as well, probably early 70s.”

Injured nine year-old girl in Gaza
In the Gaza European Hospital, March 29, 2024. A nine-year-old girl, whose dead and damaged skin was removed, called debridement, by Dr. Sidhwa and an orthopedic surgeon. “She screamed in pain and terror whenever we touched her,” Dr. Sidhwa said. His colleague also repaired a devastated left femur bone. Luckily, she survived.

War surgery is not peace surgery. And broken bones in war, from blasts or penetrating missiles are “dirty,” as surgeons call it. They require repeated cleaning out of the dead tissue as well as metal rod scaffolding outside the body to secure the bones until the muscles and soft tissues heal. After surviving death or amputation, broken bones in war require grafting, reconstruction and rehabilitation: a grueling road.

Although the war-wounded littered the hospital’s wards, finding patients and getting surgical time was not always easy for Dr. Sidhwa. The emergency room was run by volunteer medical students and the surgeons who were left were overwhelmed. Surgical residents were left to perform their work without supervision; paper charts and surgical plans were often lost or not communicated. Many surgeries happened at night, after Iftar, when the daily fast of Ramadan was broken. “Even the calendar conspired against these patients,” the doctor said.

“We found a young girl, four years old, on the ward today,” he texted on March 30. “There’s an acronym here. She’s a WCNSF. It means ‘wounded child, no surviving family.’ “

“This girl’s legs were so severely injured that there’s about a three-inch portion of her femur [long leg bone] missing, giant necrotic [dead tissue] wounds on both of her buttocks and the back of her left thigh. Maggots growing, and it is terrible,” he added. She was taken to the operating room and worked on for three hours. She survived.

The longer Dr. Sidhwa stayed, the more the bombardments increased.

The morning of April 1, he left a voice message: “The explosions are definitely getting more frequent around the hospital and seem like they’re getting closer. None of the Palestinians are even remotely concerned, so they must not actually be close, but you can smell the explosives in the air and the debris and dust actually gets into your eyes while you’re walking around now. And we’re losing water and electricity more often. And the sewer system flooded over yesterday, which I guess isn’t surprising when 12,000 people are occupying a space meant for 600. But thankfully the OR is still functioning and we can still keep working.”

So Dr. Sidhwa kept operating, and he texted on April 4: “Last night also did a loop colostomy [bowel opening diverted to the abdominal wall] on a 9-year-old girl who’s the size of a 5-year-old to divert away from her terrible buttock wounds. She has some of the worst injuries I’ve ever seen in a child that size who wasn’t dead.” Her name is Jouri.

“She was injured in a bombing where her mom and dad weren’t at home. They were out,” he said. “And all of her [seven] siblings were injured” and brought to Kuwaiti Specialty Hospital where her mom stayed, and her dad was with Jouri at Gaza European Hospital.

“He’s just so in love with this little girl,” Dr. Sidhwa said. “Finally, once these wounds were debrided and her sepsis went away, she went from being this like meek, terrified child to going to being like this spunky 9 year old. And she’s, like, started demanding chocolate and honey melon anytime she was going to get more debridements. And so her poor dad had to go out and try to find honey melon,” adding, “we started giving him chocolate for her, when she woke up, so he didn’t have to go.”

Injured baby in Gaza
An 18-month-old girl with scald burns after falling into a pot on an open flame. Most of Dr. Sidhwa’s patients were women and hildren. 

Dr. Sidhwa left a voice message as he walked toward the Medan, hearing what has become a branded background beat to this conflict: the buzz of ubiquitous overhead drones.

“There’s drones overhead right now,” he said in the message. It was an unexpected noisy mix of whirring drones overhead and babbling children at play on the ground below. “I don’t know if you can hear them. I’m walking outside. Over to the Medan, where I stay. But you know the drones, they’re constantly overhead, like literally 100 percent of the time.”

The blasts grew closer: “Today was the first day that we felt blasts that actually shook the hospital. I haven’t been able to read the news here because the internet connection is terrible. But I’m guessing the Israeli fronts getting closer? But I have no idea,” he said.

“But yeah, today, the blasts from whatever military hardware it was, I realized, it could actually be felt in the hospital. That was the first time. Even indoors, you can feel the pressure change. You know, your ears pop slightly. Not terribly, but they, the ears pop. You notice it all of a sudden, you kind of catch your breath for no reason. And then, then you feel it.”


We welcome your comments on this article.  What are your thoughts on Dr. Sidhwa's account in Gaza?

Dr. Catherine Mullaly is an anesthesiologist, global health physician, writer and journalist based in Boston. She graduated with a master’s in public health from the Harvard T. H. Chan School of Public Health in 2010 and has an M.S. in journalism from the Columbia University Graduate School of Journalism in 2015. @MullalyMD

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War Surgery Is Not Peace Surgery: An American Doctor in Gaza
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