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In July of 2024, Palestine Square sat down with Dr. Abdullah Ghali, a Palestinian doctor based in Houston, TX who visited Gaza in April of 2024 alongside a contingent of medical staff from FAJR Scientific. While in Gaza, Dr. Ghali treated patients wounded by Israel's ongoing genocide against Palestinians — a genocide which has claimed a minimum of over 62,000 Palestinian lives according to local authorities. 

Israeli attacks on Gaza have destroyed existing healthcare infrastructure while Israeli soldiers have killed thousands of medical staff and tortured others, making the treatment of survivors difficult. Dr. Ghali's visit to Gaza came just before the closing of key border crossings and the banning of medical missions into Gaza. Last April, Dr. Ghali was able to bring 80 suitcases of medicine over the crossing — now, medical supplies in Gaza dwindle, with limitations imposed on the quantity of medicine brought in. 

Despite these setbacks, Palestinian doctors hoped the recent ceasefire agreements could offer the alleviation needed to rebuild the healthcare industry in Gaza, which the United Nations found was deliberately targeted with bombings by Israel. These hopes were crushed when Israel broke the ceasefire last week. 

Dr. Ghali, whose family is from Gaza, grew up witnessing the aftermath of Israeli attacks on Palestine, often visiting the Jordanian military hospitals where Palestinians were transported for medical treatment — nurturing his desire to one day become a doctor. 

Today, Dr. Ghali is a celebrated orthopedic surgery resident in Houston. Dr. Ghali spoke to Palestine Square about what he saw, heard, and felt last April as he provided medical care to the injured in the wake of the total decimation of Gaza's healthcare infrastructures.  

Is this the first time you've worked in a war zone or in a humanitarian crisis? Did any of them prepare you for this?

I grew up in Jordan. The Arab Spring happened during my teenage years, so we saw a lot of refugees coming in from numerous countries around. I witnessed the war in Iraq back in 2006 when a lot of Iraqis came to Jordan. I was volunteering in numerous Palestinian refugee camps, so that was probably the closest I've gotten to volunteering in a war zone. And I would say none of that prepared us for what we experienced in Gaza. There were numerous workshops that we attended, hosted by the UN and other organizations. We listened to people talk about their experiences. Until you are on the ground there and see with your own eyes, nothing you read, see, or hear about will prepare you for the dire situation in Gaza.

What types of injuries did you primarily work on? What was notable about them? What might they say about the weapons that were used?

I am an orthopedic surgery resident. I am currently a trainee, and I was assisting attending orthopedic surgeons in Gaza. Some were what we were used to seeing here in the United States: hip fractures, wrist fractures, any sort of open fracture with bone sticking out, people falling from a height, or falling while standing, running, breaking their bones. In Gaza, we treated full-body burn injuries due to airstrikes, performed amputations, and gunshots to the head, neck, shoulders, and knees.  We saw a significant amount of debilitating injuries sustained in November and December 2023 and in January this year that were left untreated. Their condition had worsened: you had a chronic manifestation of an acute problem that, at the time, would have been relatively straightforward to take care of, but now is very complex. We performed many amputations that were not necessary had the injuries been treated earlier. We also saw lots of infections and malnutrition. In terms of weaponry, burns from explosives were very common to see, as well as crush wounds from buildings falling on people who stayed under the rubble for days and days on end.  People were coming in with poor blood flow to their limbs, and oftentimes they would lose all of their blood before getting to the hospital, and even when they did get to the hospital, we barely had any blood to give them.

There have been reports that the genocide in Gaza is a mass disabling event, where the entire population becomes disabled in some capacity after a bombing, and even if not everyone in a family is injured or hurt, primary people who can get food or water are often disabled or hurt to where they can't support the family, and everyone suffers. Can you speak to disability in Gaza or what you saw especially in terms of the manifestations of chronic issues? 

I think most people who advocate for Palestine hyperfocus on the number of deaths and not necessarily the injuries that are occurring for people who are still alive. The youth — 20- and 30-year-olds — are unable to walk, unable to provide for themselves, and unable to find shelter, food, and water. Those people end up having a slow death because over there, there are so few resources, the inability to gather your own resources and move from one safe zone to another is a death sentence. This was something we had to take into consideration when we were treating patients. Some have sustained fractures that need time to heal before they can walk again, sometimes taking months.  To have someone — who is the main provider — off their feet for over a month means that their family does not get food, water, or any access to medical treatment. Many of my patients would tell me about people who lived in the tents near them, who had no way of getting to the hospital because they were the primary provider. Their kids or their elderly parents couldn't carry them. I don't think people have realized the scale of disabilities that now exist in Gaza.

Can you describe a day during the mission in April? 

The days in Gaza were very fluid. When our day would start and end depended on when mass casualties would arrive. I was once awake for 48 to 72 hours straight. All the doctors who chose to stay at the hospital slept in one small room. Because there were admissions of mass casualty after mass casualty, we had to be constantly there to support either in the emergency department or in the operating room. So the days usually started around 9 a.m., which was when surgeries were scheduled to begin — a little late in order to give staff the opportunity to sleep in since they were fasting all day. I was on a mission during Ramadan. We had cases during the day from 9 AM until five or 6 in the morning the next day. To be able to go to the hospital, you need clearance from the Israeli military — permission to go on the road leading to the European Gaza Hospital. It sometimes took us 2-3 hours to drive 2-3 miles. So, half of us chose to stay at the hospital at all times, and half of us would go back to the safe house after a shift is done. The ones at the safe house would request clearance to depart at about 7 a.m. and sometimes wouldn't make it to the hospital until 10 or 11 a.m. And if the Israeli military is asking you to leave the hospital by 6 p.m., then you're only doing two or three surgeries. So, our effort in treating cases was just basically a drop in the ocean.

Can you speak to trauma care in Gaza?

Between patient cases, what we would do is we would run down to the emergency department and try to help out as much as we could, and that includes resuscitation and acute fracture care. I mostly took care of patients who had fractures or performed any resuscitation I could do. Thankfully, emergency medical physicians [arrived], so we followed their lead and helped out as much as possible. The emergency department was understaffed: it was a very small ER with four resuscitation rooms and 10 beds. Most of the time, physicians were shoulder-to-shoulder. You just had patients all over, begging for a doctor; someone sees x for that, y for that. It was nothing short of chaos. On my second day in Gaza, the sewage pipe burst in the x-ray room. You had 35,000 people seeking refuge in that hospital using the facilities, so it blew up in the X-ray room. We couldn't even run X-rays anymore. Moreover, there were only six operating rooms at EGH: one for neurosurgery, one for cardio-thoracic surgery, and four for any subspecialties, plastic, ENT (Ear, Nose, Throat), maxillofacial, orthopedic, etc. Sometimes, all operating rooms were occupied and doctors were operating. You'd sometimes have a patient come in who has to go to the Operating Room (OR) right away. We'd say ‘Let's have this patient, let's park him down here for a little bit, send him upstairs when we can.' When we could finally take the patient to surgery, we would often struggle to locate them. There were so many people in that hospital. There was no Electronic Medical Record (EMR), no pagers, and no way to communicate with others [physicians who may be needed]. So, like, if I need a specialist from the vascular surgery department to come to see a patient, there's no pager or cell phone or app or EpikChat [an EMR-based messaging app], EMR, there's no way for me to do that. If I want to know where one of my patients is, the only way to know that is to go each and every hallway and search for them. I once had a patient whom we took to the operating room at three in the morning. He had pretty bad fractures in his wrist, and he had an open wound that was just draining pus — there was pus everywhere. It took me 45 minutes to an hour to find that patient or any relative to get consent to admit him to surgery. And I had to find other staff to help me find them. Logistically, it was a nightmare.

You're talking about a lot of lost time. Because you already had really limited time to be there, and there's a lot of lost time finding people, I'm wondering, you mentioned a consent form, do you have to follow the rules and procedures that are outlined for the hospital during times that aren't ‘war-torn,' of course, violence in Gaza is ongoing, but do you have to continue to follow the procedures of documentation and consent forms, and all of those things when these situations are so urgent and you have such little time?

In a situation like this, you may think that following rules and procedures at the hospital are not necessary, but we did so anyway. We wanted to be cognizant of basic guidelines of patient autonomy and prioritizing their welfare. We wanted to make sure we were taking care of people and not subjecting them to any violation of their rights. Documentation was also very important to us because there was no electronic medical record. We had these patients with 10+ injuries, lots of debilitating injuries, requiring very extensive treatments, and most people don't have very high health literacy. Even the average American will not be able to explain to you every single thing that was done to them in terms of treatment. And so, we tried to document patient histories as best as we could, but because there was no consistent personnel there — you had a team come in for two weeks and leave — a lot of things were getting lost in transition. Some patients were coming in with no record and so would try to explain to us what was going on. You couldn't verify what they were saying because you had no x-ray to refer to and you didn't really know what was done other than what they're telling you, so you're taking the patient's word for something that could impact them. Our work was self-driven more than it was dictated by policy and procedure.

In a Newsweek Op-Ed, you speak about how children often don't get picked up from the hospitals in Gaza because Israel has killed their parents. What happens to those children?

Those kids often don't know where they are because they are found by EMTs under the rubble and brought into the hospital, sometimes by car, sometimes by foot, and sometimes in a donkey cart. Oftentimes, they are admitted alone, without accompanying family members, and require immediate surgery. When that happens, we take them into the recovery room and then we ask the nurses, ‘Where is their family? Who is going to come and pick them up?' Sometimes the kids come by themselves with very bad injuries and we have to admit them and send them to the operating room right away. Sometimes they're lucky and a neighbor shows up and the kid recognizes the neighbor. Sometimes an uncle shows up, or a family friend. But a lot of the time, no one came. And it's not like in the United States, where if that is the case, you can access a social worker or a Child Life specialist. That is not the case over there. The hospital staff would just tell us, ‘Don't worry about it, we'll take care of it, just go on to the next surgery because we need you guys to keep operating.' Sometimes the children just stay in the recovery room until someone comes. When no one comes, the hospital staff will check on the kid who would stay in the hospital corridor because there are no beds available. And God knows what happens to those kids because literally, no one is there to pick them up. Even when the children's parents are alive, they don't know where their children were taken. They usually have to go to multiple hospitals looking for them.  Their kids have no way to communicate with them — it's like living in a stone age. Phone signals are only present in very limited areas, and when you're outside of those areas, that's it. You have no way to communicate with the outside world.

As a doctor, you must contend with constant life-or-death decisions. In your case, they are also decisions of scale.  Was there a particular decision that stood out to you?

Honestly, every day. Every single day, every single hour, you had to think, ‘this patient that might die just came in and needs blood, antibiotics, surgery — do we give it to them or to the next patient across the door who's also in a similar situation but maybe has a better chance of survival?' And being in that role where you are making decisions for who gets care and who doesn't is very difficult, because you want to be very judicious with the resources you have and mindful of what's going to be a meaningful recovery.  Here, in the United States, patients can be sent to the ICU for weeks on end and you can expect some sort of recovery after continuous blood pressure management, organ failure management, etc. Whereas in Gaza, you don't have those resources available. That ICU bed that one patient could take for one month, two months,  ten other patients are waiting to take it.  

What did Gaza teach you? Do you plan on returning in the context of healthcare? Has the way you practiced medicine changed since returning?

I decided that I wanted to be a doctor because of my love for humanity, and treating people, and because of what I had seen firsthand, disabling injuries that were inflicted upon innocent bystanders — my people — growing up. Before I entered Gaza, I was just surprised at how going out and saying ‘it's wrong to kill children and women' is a political statement, and how some people will argue back on that with ‘well, they did this, they did this.' When I went there and saw, firsthand, the horrors, the carnage, the smell, the destruction — seeing all of that and not seeing every single person with any ounce of humanity advocate against this…it left a very bitter taste in my mouth. It made me see that not necessarily everyone has full regard for innocent human life. I should not be forced to say that it is wrong to shoot a 12-year-old in the head with a sniper rifle. I should not be forced to say that putting a hospital in a situation where there's no anesthetic left, so you have to do an amputation on a child without anesthesia [is wrong]. These are not conversations we should be having, but we are, and it seems that when people open their phones, they're sympathetic, and when they return to regular life — me included — it's just difficult to go to sleep knowing, seeing what we saw. There's a very heavy survivor's guilt on all of us, all of us want to go back. I have tried, but I am not allowed to go back*. In all honesty, I practice medicine now almost the same way that I practiced before I went to Gaza, and it feels that my experience in Gaza was an out-of-body experience. I'm just very grateful for what we have. I know that my experience in April, and all the years prior, have prepared me to be an orthopedic trauma surgeon.

I remember the first day we came back [to Houston] — the fact that we had lights in the operating room, anesthesia, and the patient was unconscious for surgery — it made me very grateful for these things that I took for granted. That we have sufficient supplies, we have sufficient pain control, I can put an order in a computer [and] it will happen, I can request a lab for a patient, I can request an x-ray and get it the same day, my patients get the care that they need — it makes me very appreciative but it also increases the survival guilt because you know that your patients in Gaza did not receive 1% of this level [of] care.

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*See denial of entry for healthcare workers with Palestinian roots: https://www.palestine-studies.org/en/node/1655910