In the Spring of 2023 – before the genocide – Dr. Tammy Abughnaim, a Chicago-based emergency medicine specialist, was preparing for an important visit to Gaza in the Fall. Med Global planned to send a team of doctors to spend two weeks at Nasser Hospital teaching emergency medicine residents how to use portable ultrasound machines in trauma and critical care. The trip was intended to uplift skills vital in a region where the Israeli blockade creates relentless obstacles to health care delivery.

Scheduled for Oct. 17, 2023, the trip would never come to be. As just less than two weeks prior, Israel waged a genocide against the people of Gaza targeting civilians and destroying infrastructure including hospitals and health care facilities. 

Unable to guarantee the doctors' safety, MedGlobal indefinitely canceled the trip. Devastated and begging to go to no avail, Dr. Abughnaim stayed in close contact with Med Global, urging them to consider her for future aid missions. The need finally came in 2024 when she joined an organized mission by the NGO to Al-Aqsa Hospital in Deir Al Balah, where she served from March 3 to March 21.

With the war unabating and conditions in the enclave rapidly deteriorating, Dr. Abughnaim returned on another mission to Gaza from July 25 to Aug. 15 with MAP UK (Medical Aid for Palestinians UK) at Nasser Hospital in Khan Younis.

Palestine Square spoke with Dr. Tammy Abughnaim on Nov. 21, 2024. She recounted her time in Gaza, detailing the daunting realities of providing medical care under severe restrictions and vividly illustrating the dramatic decline in conditions between her first and second mission. She highlights the deteriorating health and morale of the Palestinian people in Gaza, the near-impossibility of providing effective health care after the Rafah border closure, the shift in injury patterns suggestive of a disturbing shift in Israeli military strategy, and the invaluable lessons in resilience she gleaned from her fellow health care workers on the ground. 

Four months after this interview, Dr. Abughnaim returned to Gaza on her third medical mission where she was once again stationed in Nasser Hospital. On March 23, 2025, an Israeli airstrike targeted the surgical building of Nasser Hospital in an attack that killed two and destroyed the department. Dr. Abughnaim was on duty at the time alongside three other American doctors; they survived.

Since her return from that mission, Dr. Abughnaim continues to use every platform at her disposal to share firsthand accounts from her missions, aiming to draw attention to the desperate situation in Gaza.

This interview was conducted on Nov. 21, 2024 and has been transcribed and edited for clarity and brevity.

Al-Aqsa Emergency department, resuscitation room. Image courtesy of Dr. Tammy Abughnaim.

What motivated you to go on these missions, especially given the challenging situation on the ground and the well-documented targeting of health care workers?

After the [genocide] broke out and we saw the systematic targeting and destruction of health care institutions, it felt much more important to me that I go and stand by my colleagues in Gaza. By the time I went in March, more than 500 of my fellow health care workers had been killed. That's a huge drain on the health care system. I felt like it was important, now more than ever, to supply them with whatever assistance I could. I understood it was dangerous. Every health care worker who signs up for something like this understands that the hospital they are at might be targeted; they might have to evacuate without any notice; they might be put into compromising situations, but honestly, that never struck me as reason enough not to do it. 

What was your impression of arriving in the Strip for the first time, and how do those initial moments compare to what you thought you would see?

Within the first five minutes of our entry into Rafah in March, 2024, our bus stopped to make way for an aid truck passing through. On top of the aid truck were three men carrying guns and shooting into the air to prevent people from looting the aid. That was our first impression of Gaza – a glimpse into the extreme need and scarcity of resources, even back then. 

I don't think anyone is ever prepared to witness genocide. I was unprepared for the scale of destruction. Being in Gaza is very overwhelming on a sensory level. You can smell a combination of blood and human waste just walking out into the streets. You see rows and rows of tents lined up along the border and along the coastal road. There's a constant cacophony because a million people are wandering around this very small town. 

After my second mission, we drove through some of those same parts. The difference was astonishing. Rafah and Khan Younis were full of people in March, and now everything was decimated. Every single building had pockmarks on it or has been partially destroyed or bombed. It was heartbreaking. You wonder - ‘where did all of these people go? What's happened to all of the children that played in the streets with us? Where are they now?' And I know the answer is they've been displaced, or killed, or succumbed to death by the food and water shortages Israel has imposed on the area. 

Can you walk us through a typical day on your medical mission? Did your routine change between the first and second mission?

Every day consisted of me joining the team in the emergency department with occasional trips to the ICU or the wards if I was needed there. Most of the time I worked night shifts because that's when we were most understaffed. 

When I was in Deir Al Balah in March, most of the patients we received were victims of Israeli airstrikes who had been pulled out from under the rubble or injured in a blast. We dealt with shrapnel wounds, amputations, and traumatic head injuries. On my very first day at Al-Aqsa Hospital, we had four mass casualties in six hours. We didn't have beds and the hospital was already at three times capacity while accommodating 70 people living in the emergency department. We would just lay patients on the floor to assess them, and try to get them to the CT scanner, where we could only do scans of the head. Half the machines for monitoring didn't work.

I felt less like I was practicing emergency medicine and more like I was practicing damage control. It would be constant traumas, resuscitations, and procedures, then waiting for the next round of casualties.

At Nasser Hospital, we had a combination of medicine patients and trauma patients. Not only were we dealing with a lack of resources to aid trauma patients, but we witnessed an abundance of cases, severe dehydration, malnutrition, and chronic problems such as high blood pressure and diabetes that had gotten out of control, that couldn't be alleviated because of the conditions. You just saw kind of how everything was spiraling all at the same time. 

Al-Aqsa Emergency department, resuscitation room. Image courtesy of Dr. Tammy Abughnaim.

What were the most common types of injuries you treated in Gaza and who were the bulk of your patients? Between your first and second missions, did you observe any changes in the types of injuries or the demographics of your patients that might reflect shifts in Israeli tactics or weaponry?

On both missions, children made up at least half the casualties. In March, the majority of patients we saw had crush injuries – they were crushed under the rubble of their homes – due to Israeli airstrikes. 

I definitely noticed a shift in weaponry and tactics when I returned in the summer. In July and August, I noticed we were getting a lot of head and neck injuries from shrapnel and that the spray pattern was different. The shrapnel itself was different from what I'd observed in March. Instead of being large and flat, this shrapnel was small and cube-shaped with sharper, more distinct edges. Those small shrapnels lodge themselves very deep into the tissue and cause a whole lot of bleeding. The airway is much more difficult to control.

Given the presence of Israeli soldiers on the ground in Rafah and Khan Younis, we would see higher incidences of quadcopter attacks, too. Quadcopters are drones mounted with weaponry that are capable of shooting shrapnel, delivering gunshots, and exploding. I would very frequently observe gunshot wounds of all sorts, including many to children's chests and abdomens.

The youngest patient that I saw injured by a quadcopter was 19 months old. She was playing outside of her tent. The family saw a quadcopter fly down to her level, shoot her in the left thigh, and fly away.

I was particularly surprised by the number of young men that I saw targeted disproportionately to the rest of the population. We would regularly get mass casualties of a group of young men who had either gathered in the shade of a tree or were at a market or in a car. We even saw groups of young men that were routinely targeted. Particularly notable was the regularity with which young men were targeted with gunshot wounds to their lower extremities. Once you see dozens of young men with gunshot wounds to the groin and no other injuries, it's clear that it's deliberate. It's reproductive genocide. 

Can you describe what the conditions in Gaza's medical facilities were like? Did anything in particular stand out to you about the environment in these hospitals?

I can only describe it in the way that every human rights organization has described it — catastrophic. Because of Israeli restrictions, we lacked basic equipment like tourniquets and suction catheters. We didn't have any specialized pediatric equipment, which is terrifying when you consider that over half the victims we receive are children. 

We were always short on tourniquets, so we were tying up people's mangled limbs with giant rubber bands or Foley catheters. Sometimes our pulse oximeters and blood pressure cuffs would not work. There were limited numbers of ventilators, and as a result, we had to reuse the same ventilator and its tubing on different patients. 

Since Israel does not allow [the entry of] soap, bleach, and disinfectants, infection control was a huge problem. This was particularly the case in July and August since entrance through the Karem Abu Salem (Kerem Shalom) crossing meant total Israeli control over what was being brought into the Strip. We saw a proliferation of flies and insects, and it was not uncommon in the ICU for nurses to be pulling maggots out of the mouths of intubated patients. We could not sterilize anything. The best we could do was wash things with water and iodine. If we were lucky, maybe once a week, somebody would find some soap. I ended up sneaking soap into Gaza the second time because I knew the shortage was going to be a problem.

Aside from an equipment shortage, the general environment in the emergency department was difficult. Since the AC didn't work, windows had to stay open, exacerbating infection control with flies everywhere. There was no way for us to swat all of the flies away to prevent them from landing on wounds. This reality may very well increase mortality because wounds need to be kept clean and dry.

Nasser Medical complex resuscitation room. Image courtesy of Dr. Tammy Abughnaim.

Were there any particular cases that stood out to you during your time in Gaza?

There was one in Khan Younis that troubled a lot of us. It was the case of two children who were killed whilst playing. That morning, evacuation orders had been issued for the blocks next to the hospital. People were frantically looking for shelter because they knew that their apartment buildings were going to be bombed shortly. I remember seeing hundreds of people at the hospital gates seeking safety. A few hours later, we received two children at the emergency department. The parents explained that they were sheltering in a cemetery thinking that it would be safe. Their children were playing and found this large green disc in the dirt. One of them picked it up and it exploded. The first child that was brought in was mangled beyond recognition. He was about 10 or eleven years old and had a huge crater on his forehead. Part of his thigh was missing and his right arm was completely blown off. He was dead on arrival. The child who was with him came in five or 10 minutes later, carried by his family. He had extensive injuries including abdominal bleeding from shrapnel. He was taken to the operating room almost immediately, but I don't think he made it out of the hospital. He sustained such severe injuries that they were irreparable.

I remember a moment when all five doctors present stood around the bed, looking at each other in shock. Even some of the seasoned Gaza doctors were horrified. You do not expect to see children becoming victims of land mines and you especially don't expect land mines to be planted in cemeteries. At that moment, a lot of us felt demoralized.

Another case that stands out from my time at Al-Aqsa Hospital which I can hardly talk about without breaking down and crying, was the case of two [baby] cousins who had come in after an Israeli airstrike on their home. They were pulled out of the rubble, and both sets of their parents were [killed]. One of them was six months old, and the other, a nine months old. We put them on the same bed, and we were working on them simultaneously. The younger one had bruising around his head, probably some very traumatic brain injuries and internal bleeding. We knew this because he was very pale and very cold. His cousin, the nine-month-old, was in a similar position. She had a head injury, a face injury, and abdominal bleeding. We proceeded to resuscitate them and supply them with blood. The nine-month-old began to perk up and do better, but the six-month-old was not doing well at all. We then got word that another mass casualty was coming in. We weren't even done [treating] the victims of the first one, and here we were getting more. There are only two ventilators in that emergency department. One was being used by an adult, and the other one was being used by the six-month-old. We were told that the victims of the second mass casualty were also going to need a ventilator. All the doctors present just looked at one another because we knew the choice we were being forced to make. We thought among ourselves — ‘do we continue to work on this child and try to give him a shot, or is this a futile effort?' We decided that he probably would not make it, so we would have to take him off the ventilator. We took the tube out of his throat and waited for him to pass. We then took his little body away and made way for the next victim. That to me highlighted the extremely difficult choices faced by health care workers in Gaza as a result of Israeli restrictions. Nobody should ever have to make that choice. It's a huge contributor to the moral distress that these health care workers are experiencing. 

Did you notice any difference between the first and second missions in policy, restrictions, etc.?

I did notice a huge difference in the policy surrounding entry for humanitarian aid workers. Regarding movement, everything had to be coordinated with the Israeli-run COGAT [Coordinator of the Government Activities in the Territories]. They govern the rules about who enters, who exits, and what is allowed in and out. 

In March, when the Rafah border was open, we were not limited in terms of how many bags we could bring, or the number of personnel that could accompany us. This was because much of COGAT's influence was mitigated by the Egyptians who allowed us to bring in almost anything we wanted, except some heavy machinery and equipment which would not be approved. On my second mission, Rafah was closed so we were obligated to enter Gaza through the Karem Abu Salem crossing which is entirely controlled by Israel.

COGAT categorically denied us permission to bring in any strong painkillers like ketamine, morphine, or opioids — medications that were already in critical shortage as far back as March. With the extent of Israeli attacks, countless individuals are left to suffer excruciating war injuries and endure invasive surgeries without any pain relief whatsoever. How can Tylenol be considered a weapon?

The guidance we were issued by the WHO and COGAT was a maximum allowance of one bag, and that one bag cannot contain any medical equipment. If it is found to contain medical equipment, you, potentially alongside your entire convoy, will be turned back. Even if you are willing to take a chance, you're risking 20 people being sent back or being delayed, a risk you do not want to take.

The number of personnel that were allowed to enter and exit every week is also very tightly controlled by COGAT. When Rafah was open, dozens upon dozens of humanitarian workers were entering on any given day. In July, we were only allowed 21 people per convoy, and only twice a week. Due to the regular Israeli bombardment of humanitarian convoys, aid personnel must now travel in armored vehicles once they have entered Gaza, and these vehicles only contain 21 seats. So our ability to get in, carry the equipment that we need, and, ultimately, provide critical care was incredibly different between March and July.

The general state of the people of Gaza was also different between both missions. In July, I could immediately see the effect of the Rafah border's destruction on the civilian population. Everyone is much hungrier, skinnier, and generally more malnourished. The closing of Rafah has also psychologically destroyed a lot of the hope that people had. As long as Rafah was open, there was a way to get things and people in, and there was a way to get people evacuated. Now, people are in a limbo state. The number of medical evacuations that have taken place has dropped significantly. Nobody who is not a medical evacuation is being let out. Students who have acceptances to continue their medical education at universities abroad cannot leave because Israel won't approve their exit. Everybody feels that once Rafah closed, a lot of their options also closed. They feel trapped and that this has sealed their fate in many ways. Many of them tell me “We're just waiting for our turn to die.” They say they don't anticipate Rafah opening in the near future, and don't think Israel will stop their onslaught anytime soon, so they are just waiting for their time to come.

Khan Younis. Image courtesy of Dr. Tammy Abughnaim.

I'd like to ask about the conversations you've had with your patients and the local health care workers you worked alongside. Have any of them communicated to you words you feel should be heard or shared any messages they wanted you to convey to the world?

Many people tell me they wish they were dead. Children have told us “I want to die so that I can join my family in heaven. I don't want to live here anymore.”

I did my best to convey to them that there are millions of people around the world protesting what is happening and calling for a ceasefire. Many of my colleagues had said the only time they felt like they had hope was when they saw the student encampments. For some, it was reassuring that there were people on the outside who cared about them. But still, they were demoralized because no matter what happened outside, they were still subjected to Israeli bombings and shootings. It's hard for them to project into the future, nothing is changing fast enough.

While speaking of the encampments, I reminded them that those students protesting today will be the future politicians and decision-makers, and they will fight to make sure atrocities like this never happen again. That idea seemed to comfort them a little bit. It made them think that even if nothing changes now, maybe something changes for their children or grandchildren. 

The message health care workers wanted me to convey most was not to forget about them and how they're fighting to the best of their ability against death and destruction every single day. They asked me to tell their stories about being detained for 30, 40, 50, 60 days, sometimes five months, and tortured by Israeli Forces for doing their job. They wanted me to share stories about what I'd seen and heard so that it's impossible for anybody to go a day without hearing about Gaza and to fight for the change in their circumstances.

How did you and your team cope with the emotional toll of witnessing such severe trauma? Did you adopt your resilience from the Palestinian people? How did you navigate what you experienced in Gaza?

I learned to cope by watching my colleagues. After a particularly harrowing night, I was determined to keep working but an ER doctor at Al-Aqsa pulled me aside and insisted we step outside for fresh air and coffee. He explained to me that in order for us to keep going, we have to steel ourselves for the long run.

A combination of humor, patience, and faith also seemed to keep them afloat. Planning for the future was important in maintaining resiliency. Ghassan Abu Sittah says that envisioning the future defies the finality of genocide. Doctors would often talk to me about plans to return to their homes and rebuild their lives. There is a sense of “we are not going to be exterminated; we are still here.”

Why do you think it's important that these stories are shared?

Sharing these stories is crucial because it brings the reality of genocide, often seen as distant, directly to people's attention. I must talk about what I've seen and recount the stories I've heard because it humanizes Palestinians to a population that is so used to their dehumanization. Only through humanizing can we foster connection and understanding.

We have an obligation to everybody everywhere. Being human means helping and serving others, whether it's through listening to their stories, sharing their stories, or being on the ground and offering direct aid. Recognizing and acting upon our shared humanity is essential; ignoring it diminishes our own.

Nasser Medical Complex courtyard, site of mass grave. Image courtesy of Dr. Tammy Abughnaim.