Editor’s note: We interviewed Dr. Ali Elaydi twice, once on May 18 after his first medical mission to Gaza in April, and the second time on June 17 after he was denied entry to Gaza while embarking on the second medical mission to Gaza. Below is the second interview, you can read the first interview here.
TW: This article includes two images showing a leg being operated on, blood is visible.
Upon launching its ground invasion of Rafah on May 6, the Israeli Occupation expedited the isolation and suffocation of Palestinians in the Gaza Strip to aggravate annihilation and ongoing genocide. Demolishing the Rafah border, Israeli Forces have restricted aid entry to the Karem Abu Salem (Kerem Shalom) and Erez crossings. Minimal aid has been further deprived through both crossings. Evacuations, including those of medical necessity, have been halted. Israeli Occupation Forces (IOF) continue to establish increasingly restrictive policies to paralyze Gaza's health sector; from banning entry to doctors with Palestinian ancestry on medical missions to capping the number and type of equipment and medication permitted into the Strip.
Dr. Ali Elaydi is an American orthopedic surgeon based in Dallas. Born in Gaza, he immigrated with his family to the U.S. at five years old. He completed his residency in orthopedics at Yale before moving back to Texas, motivated to pursue medicine by the prospect of conducting care in Gaza. He completed two medical rotations in Gaza during his undergraduate studies, specifically obtaining training in global health and mission work. Dr. Elaydi currently has relatives being subjected to indiscriminate bombing with barely any access to medical care. In April, he entered Gaza on a medical mission for two weeks providing necessary medical attention to Palestinians severely wounded by Israeli bombs. He spoke to Palestine Square about his experience on the first mission in an earlier interview.
Dr. Elaydi recognized the dire need for medical personnel, medication, and equipment in Gaza. To him, one mission was not enough, so he prepared to embark on a second in June. This time, he knew what he was walking into, he knew what doctors in Gaza needed, and packed accordingly. After weeks of planning, Dr. Elaydi arrived in Jordan on June 10, expecting to cross the border into Israel and enter Gaza via Karem Abu Salem in five days, but was denied entry “due to [his] Palestinian roots,” on June 13th. He says he was not the only one.
The Israel-run Coordination of Government Activities in the Territories (known as COGAT) mandated new restrictions on medical missions. Dr. Elaydi was informed in an email sent by the World Health Organization, and also in a text message, that the new policy from COGAT states that “anyone with a Palestinian background (or roots) will be denied border crossing through Kerem Shalom.” The email, seen by Palestine Square, further “STRONGLY” advised against any attempts to enter Gaza with a Palestinian background including “(with or without PAL ID, such as being born in the [Occupied Palestinian Territories]; including parents or grandparents).”
Dr. Elaydi said that wasn't the only newly mandated policy. He shared that, compared to his first mission, COGAT restricted the amount of luggage allowed into Gaza from 10 to 2 suitcases (later reduced to only one), declared that no medication or medical equipment is permitted except for personal use, no more than 12,000 NIS ($3,000) per person, and required that missions commit to one month instead of a two-week entry.
There has been criticism by social media users of medical missions not recruiting doctors with Palestinian ancestry. Many social media users are not aware of Israel's newly mandated policies which the media have barely reported. In a tweet on July 15, Fajr Scientific, which has been organizing medical missions to Gaza, said that “[their] policy explicitly opposes any discrimination based on ethnicity, color, background, religion, etc… Unfortunately, the Israeli army requires that anyone entering Gaza, whether medical personnel or otherwise, must not have a Palestinian background, regardless of their citizenship.” They referenced the rejection of Dr. Elaydi, and said they “hope these restrictions [are] lifted” as a significant number of their volunteers have Palestinian heritage.
On June 28, NPR reported on these restrictions interviewing Dr. Elaydi and others. Through several interviews with doctors and aid groups, NPR reported on how the Israeli limitations imposed on the “effectiveness of medical expertise going into Gaza, where most hospitals have been destroyed or heavily damaged and local medical personnel has been killed, wounded or repeatedly displaced.” NPR also reported that “neither Israeli officials nor the WHO or the State Department responded to requests for comment.”
In this second interview with Palestine Square, Dr. Elaydi spoke about the conditions on the ground in Gaza, the short- and long-term impact of these restrictive policies on Palestinian life, and the critical need for an immediate ceasefire alongside the intervention of medical aid.
This interview has been transcribed and edited for clarity and brevity.
As you prepared to embark on a second medical mission in June, you were denied entry to Gaza. How were you informed about the policy? And how do you think these changes will affect the capacity of doctors entering Gaza to help?
This was my second medical mission to Gaza, my first was in April. The application went through the channels of the United Nations, I was told that I was approved. So, I flew to Jordan first, but once I landed the World Health Organization, who was coordinating our entry, informed us that everyone on "the mission has been approved [entry] except for Ali Elaydi. He was turned away, rejected formally due to his Palestinian roots." I received this information in a text message. I arrived in Jordan on Monday, June 10, and received this text message on June 13th, two days before our scheduled entry. Something similar happened on our previous mission where one doctor was refused entry 10 hours before. He had patients waiting for him and 10 suitcases of resources packed. These are last-minute decisions, and this policy [enforced by COGAT] was last minute. I remember I was posting a picture with my team saying we were going to enter Gaza in a few days, and it was around that point that I realized I wouldn't be able to enter after arriving and making treatment plans. I was planning on following up with patients whom I treated in April. There were a couple of cases that were waiting for me and a couple of patients that I knew needed specific operations. Before arrival, we tried to coordinate and make sure that we were ready for everything once we got in. This time, we knew the mission was going to be completely different from the last. The policies had changed. We were extremely limited in what we could bring, only two suitcases, then reduced it to a single suitcase per person entering Gaza. We were unable to bring in any medication intended outside of personal use. It seemed like the Israeli authorities were introducing new policies to make giving aid to Gaza nearly impossible. It's also unfortunate that Palestinian physicians can't help their people. We're just as capable and qualified to be able to deliver care as doctors from other backgrounds.
We're being regarded as if we're incapable of self-governing and we're unable to care for ourselves. Many Palestinians went into health care to be able to treat in Palestine. They're trying to prevent any display that we can provide a high standard of care, and that we are high-achieving individuals. Unfortunately, I know many who have been pulled from their mission trips because of their background. This is a new policy that all medical aid organizations are currently dealing with. I believe they want to make the Palestinians so reliant on other people and outside aid that they feel that we are unable to do anything for ourselves. Right now, no Palestinians are allowed to enter Gaza and no Palestinians are allowed to leave.
Thankfully, many international doctors are contributing to the health care of Gaza. However, the policy restricting entry to medical personnel with Palestinian roots seems to be [targeted].
How did you feel when you were sent back? How did you anticipate the restriction of your specialty at that moment would affect patients moving forward?
Learning that I was not allowed entry to my birthplace was soul-crushing. I couldn't process it — I was born there and couldn't return, even though my only goal was to do humanitarian work. I was the only orthopedic surgeon on that mission in June, patients [have] suffered from lack of care. Israel's [restrictive] policies [on equipment, medication, and personnel] are denying Palestinians in Gaza care. Thankfully, the medical mission that followed the one in June had an orthopedic surgeon, [not a Palestinian.] Patients had to wait. Orthopedic care is one of the most necessary specialties in Gaza right now due to the types of injuries sustained from Israeli bombs.
Can you describe the conditions of the hospital you worked at during your first mission trip in April?
When I was on the mission in April, we worked at the European General Hospital on the border of Rafah and Khan Younis. The hospital, which had a 200-bed capacity, was housing 35,000 refugees. Every space, including hallways and outside areas, was occupied. Tents were set up in halls, making it difficult to move. Sterility was almost nonexistent, with flies in the Operating Rooms and lights going out mid-surgery. Infection rates were over 50%, and we often dealt with complications from surgeries conducted by physicians who were on the mission before us. I was certain that doctors coming on the mission after ours were going to be cleaning up the things that we did. That's just the nature of the conditions in Gaza right now.
[Editor’s Note via first interview: In early July, Israeli Occupation Forces ordered the evacuation of the hospital, leading to the displacement of staff, patients, and refugees, as well as the confiscation of medical equipment. Dr. Elaydi says that the hospital is preparing to reopen and staff are restocking supplies with the help of incoming medical missions to resume operations.]
What kind of preparation did you have at the time? What shocked you when you arrived?
I've been on a couple of missions before Gaza, I went on a mission to the Dominican Republic during my residency where we performed highly complex scoliosis surgery on pediatric patients. Mission work has always been really important for me, I didn't want to be one of those people that just talked about it in a personal statement or an interview. My research and Grand Rounds were on global health and mission work, so it is important, and I've done it in the past. However, in Gaza, it was a different situation. I've never been on a medical mission during an active war. The resources we were allowed to bring with us were limited and travel was very difficult, and the injuries I treated in Gaza were extremely different. A lot of the mission trips that I've been on in the past have had patients with chronic orthopedic issues. In Gaza, this was acute trauma, wartime trauma — blast injuries, gunshots. A lot of my mission trips focused on congenital issues and chronic issues. These, however, were intentionally inflicted, man-made human trauma… Some of the worst orthopedic injuries that I've ever seen in all my training.
Are there any cases you reflect on from your first mission that exhibit the immense impact of this policy on aid and health care in Gaza?
One of the cases that stands out to me the most was in the emergency department. A seven-year-old child was brought in after a bombing with his femur sticking out of his leg — he had an open femur fracture and a jaw fracture. He was barely interacting with us, and his parents were at his bedside, obviously in a very panicked state. There was only one oral surgeon available in Gaza at the time, so while I was down there seeing the patient for the femur, I needed to coordinate care for his jaw as well. The oral surgeon was supposed to be leaving the following day and was planning on being out of the hospital by 5 p.m., to go home and pack his things to leave in the morning. I asked him if he'd be willing to stay overnight and have his team pack up his bags so he could leave for Egypt from the hospital in the morning. He said, ‘Absolutely, we're going to take care of this patient.' So we ended up fixing the little boy's leg, and the other surgeon fixed his jaw. Honestly, I wouldn't know what we would do in that situation. The worst thing about this was that as we were rushing this kid to the OR upstairs, another bombing injury was coming through the door. There is just a constant inflow of patients needing immediate surgery. Though you're trying to manage and triage the best that you can, there's just an indefinite amount of work, unfortunately. We also have to decide how to split our time between treating acute trauma from the war and chronic issues. We're trying to coordinate and make the best use of the resources that we have. The European General Hospital (EGH) was the only major hospital still functioning while I was there, so we were seeing a lot of patients with chronic issues. We essentially operated around the clock, morning or night, whenever you could get an operating room. Only four ORs were operating. The patients had to be split up among all the teams and we had to decide which were the most urgent cases to treat. Whenever I wasn't in the OR, I would be downstairs in the emergency department, seeing the patients with any kind of wound to offer care or discharge patients. There is an overwhelming amount of places requiring constant help. There are so many patients that there is essentially no medical record system. In one case, a week later, a patient stopped me in the ED, asking about his CT scan. I had forgotten due to the chaos. Following up with patients is hard with 35,000 people around. I checked his scan, saw he needed surgery, and booked it for the next day. It made me think: if he hadn't seen me, who would have followed up and ensured he got surgery? The conditions are dire. Given the high infection rate, you have to constantly consider what treatments you'll do. If there's a high risk of infection, anything that you put into the body has a risk of getting infected and worsening the injury. We were often putting external fixators on everything to avoid having anything within the body that can get infected and cause even worse issues. We also have to think about follow-up. The case of Al Shifa hospital being evacuated and besieged forced us to consider the ways patients would be able to hold up if such a situation arose in EGH. In Al Shifa, those who could walk left, and those who couldn't walk remained, and we saw what happened to them. There were constant warnings that EGH would face a similar fate, making this a major concern in treatment. In orthopedic surgery, specifically, we prioritized being able to get patients to walk as soon as possible. The implants and surgeries that we chose were according to what would allow patients to put weight on them quickly.
What kind of long-term effects do these missions have? What does care look like after you leave?
One major concern of mission trips is the lack of follow-up on cases. Without adequate follow-up and physical therapy, conditions aren't optimized. That's why I chose to join a medical mission organized by a group with long-term goals and frequent mission trips supplementing each other. If a patient needed secondary surgery, I could pass it on to the next team. It's extremely important because patients often get lost in the system. We try to operate so they don't need additional treatment, but you don't know until you see them. In the U.S. I see patients after two and six weeks to check their progress. They need physical therapy and nutrition to heal properly, which they can't get in Gaza. In Gaza, we relied on our efforts in the operating room and the patient's ability to heal.
I don't think anybody could be fully prepared for the extreme cases of trauma injuries that we saw. I'm confident in my ability to treat anything, but the lack of long-term follow-up and rising infection rates were a concern. Many of the patients we saw should have had surgery on the day they were injured but because of the targeting of medical facilities and lack of orthopedic access or care, their injuries were neglected for months. I treated patients who were hit during the first week of the war, six months in. This wasn't something I was trained to do, but we were taught principles to manage these conditions. You rely on your training, but sometimes you can't do much. In the U.S. we have limb salvage programs with resources and physical therapy. At Yale, we had vascular, plastic, and orthopedic surgeons working together. In Gaza, we lacked follow-up, resources, and sometimes enough surgeons, so often we had to opt to amputate due to limited chances of survival with current resources.
What was your experience entering Gaza on a medical mission as a Palestinian from Gaza yourself?
There was concern even on the first mission in April of whether I was going to be allowed in or even be allowed out. As an American citizen, I expected to be treated like an American. Unfortunately, that's not how Israel sees things. I do not have the same rights as other Americans. I went to Gaza knowing that I might not be able to leave. For me, I was returning home. Gaza is and will always be my home. All of my immediate family lives there and life has always revolved around giving back to Gaza. I studied medicine and my sister studied law so that we could benefit Gaza. That was ingrained in our upbringing. Although we were able to escape the now 17-year-long siege in Gaza, we will forever have a connection to our land, and to our people. We spent summer vacations there, regularly helped our relatives, and wanted our children to know where they came from. It's something that has always been important to me. With my family being there, I had to think: How can I help them? I knew that everything that I took for them was also taking away from the general population, but I did have an obligation to my family. Before entering the Strip in April, I called relatives and asked them what were the most urgent things that they needed. It was mostly medications that were running out in Gaza. I have a cousin who has lymphoma and hasn't been able to get his chemotherapy or evacuate to receive treatment. He's now nine months behind on treatment. He knows what the trajectory of his life looks like without treatment, but it doesn't matter. There are a plethora of patients who need to get out and just can't. It's frustrating seeing not only what's happening to everyone in Gaza, but witnessing it firsthand happening to your own family. You just feel so powerless, unable to do anything. One of the ways that I felt more empowered was in my ability to go back and help through medical treatment. I understood that what I could do was only so small considering the overall situation. Despite the amount of surgeries that I was involved in and the amount of patients that I helped, the reality is that all of that work could be reversed in a single airstrike. In a single second, everything could be reversed. The most critical thing that we can do to preserve life is to stop this war.
