On April 29, 2024, six months into Israel's ongoing genocide, Dr. Alia Kattan joined a U.S.-based medical nonprofit on a mission to southern Gaza. At the start of their mission, Dr. Kattan and her team resided in a safe house in West Rafah, operating in the European Gaza Hospital (EGH) situated between Rafah and Khan Younis. On May 6, exactly one week into the team's mission, Israel initiated a ground invasion of Rafah. Upon the expanded bombing campaign, the team evacuated their safe house on May 9 and sought refuge in EGH, where they continued to treat patients until they were granted safe passage by the UN and WHO to leave Gaza on May 17 — four days after their originally planned return.
Throughout this time, Dr. Kattan treated a rapidly increasing number of patients and witnessed the complete desolation of Rafah. Palestine Square spoke with Dr. Kattan as part of a series of interviews with doctors who have been on missions to Gaza; she testified to the rapidly shifting conditions of Rafah throughout Israel's May 2024 ground invasion.
Dr. Alia Kattan is an Iraqi American Intensive Care Unit (ICU) doctor and anesthesiologist, born and raised in Southern California. She completed undergraduate study, medical school, residency in anesthesia, and a fellowship for critical care at Stanford University, working there for one year afterward as an attending. While at Stanford, Dr. Kattan also studied in-depth global health, working in Zimbabwe, Cambodia, the West Bank, and South America. She taught either Anesthesia or ICU in each of her previous humanitarian missions. Her mission in Gaza was the first time she had entered an active war zone. She has not returned to Gaza, but she continues to administer care and offer aid from abroad.
This interview was conducted on Sept. 23, 2024. Published nearly one year after her mission and the ground invasion of Rafah, Dr. Kattan's testimony paints a vignette of the ongoing violent reality on the ground, the complete devastation of Gaza's medical sector, and Israel's apparent targeted campaign against children. She also offers critical insight into the global consequences of Israel's unrelenting genocide in Gaza.
This interview has been transcribed and edited for clarity and brevity.
An Israeli tank blocks the path of a car carrying Dr. Alia Kattan and colleagues as they leave Gaza after their mission. Dr. Kattan says, "[During] our exit, we were held up by an Israeli tank pointing at us for three hours despite us being doctors working through the WHO."
How did you prepare for your mission, and what shocked you once you arrived in Gaza?
I've worked in low-resource [environments] before. We never had to worry about [shortage of] medications because we always brought enough of what we needed, but in this case, we were unable to bring what we needed to treat patients in a health care system under attack. This was even before the increased restrictions* placed on humanitarian workers after Rafah was invaded. Now, health care workers entering through different occupied borders, who are often rejected altogether, can only bring two small suitcases. Our medical mission still ran out of medications despite coming with over 13 suitcases per person, and that is because we stayed longer than expected. That was something new to this mission, and that I hadn't experienced before; I prepared everything I would need as an anesthesiologist and ICU doctor, but it wasn't enough. Being in a health care system that was so broken was extremely difficult. Even being in a low-resource [environment], I know I'm able to access patient records, whether it's on paper or otherwise. I'm typically able to [learn] the patient's name, where [they're located], and I can talk to the patient's family. None of these options existed for us, and now they are struggling even to find paper to document medical care. I didn't have access to a patient's medical history or their labs The entire health care structure is in shambles: lack of manpower, lack of monitors, lack of medical supplies, lack of medications, lack of documentation, lack of functioning ambulances, I cannot over exaggerate the level of attack on the health care system.
Could you detail the conditions in the hospital? What did you see, smell, hear, etc.?
The hospital was filled with encampments of displaced Gazans, overflowing inside and outside. Thousands of displaced people shared the handful of hospital restrooms and other utilities. When we arrived, the halls were cluttered with makeshift tents. It was very difficult to find anything in the hospital, such as the emergency room or the ICU. There were no hallways because all of them were filled with tents crafted from bed sheets, and because of that, all the patients lacked bed sheets. Patients were lying on bed frames without mattresses, because displaced people use the mattresses and the bed sheets as their new homes. When Israel invaded Rafah, all these displaced Gazans were yet again displaced to Mawasi**. It is important to note here that this was the 7th or 8th time people were displaced to a “safe zone,” which they had learned by now, there is no safe zone in Gaza. Displacement is an exhaustion of resources, if people can get the funds for transportation and tents. After this wave of displacement following the invasion of Rafah, the hospital was completely different; there was an influx of mass casualties, but no displaced people seeking refuge within the halls. It was still very difficult to find patients we were treating or supplies in the emergency room, direct patients, or transport them to imaging, the ICU, or the OR (operating room). It was an inspiring dichotomy to see such a proud people who, despite the resources, were able to keep order and cleanliness with massive amounts of individuals now displaced across the hospital, while their entire health care system was broken. It was hard because we could see what the hospital could have been if it had those tools and resources they were stripped of. I constantly heard the zenana, the sound of the drones overhead, and 24/7 bombings. Rafah hadn't been invaded when we first arrived, so when we drove through, I was surprised to see buildings. When we left, it was completely different. Everything was destroyed after a so-called “limited invasion.” It was devastating to see with my own eyes buildings standing, and three weeks later, decimated. It was not just one or two buildings, but on both sides of the car, for hours of driving, all we could see was destruction and people walking to their next unknown destination. I saw a lot of children who lacked any security, safety, or basic needs like water and food. As soon as I got off the bus while we were staying in Rafah, kids came running to ask for food, water, or something to do. They were seeking structure and safety. I just wondered where their parents were, but I'm sure their parents were either looking for food, work, water, or were no longer with them. It was a critical point that stuck with me: the number of children lacking structure, safety, and basic needs. I also saw many patients with hopeless futures. There are the acute cases, the casualties, and the mass casualties that come into the emergency room. These cases are concerning, and they're scary, of course. It's extremely sad because you're watching so many people die, but you also have patients who are lingering in death. These patients are without resources, without pain medication, and without nutrition. Those cases were even more difficult to swallow than the patients who were dead on arrival or dead within hours. These patients are in a liminal state, lingering in hospital rooms without their families, and in pain. Some have loved ones who are watching them, wondering what they can do while their wounds are worsening before their eyes because they don't have nutrition or infection control. Infections and starvation ate away at their bodies, incrementally getting worse and leaving them bed-bound. When EGH was [ordered to] evacuate [on July 2], I wondered about these patients, because I knew they couldn't be moved. This was the heartbreaking reality for many patients.
Displacement of a family. Image courtesy of Dr. Alia Kattan.
What did a day look like in the field?
Sometimes we would work 18-20-hour days. I'm an ICU doctor. I planned to work in the ICU, but we didn't have any time to be in the ICU because we were overwhelmed in the OR. We'd wake up, go to the ORs as soon as possible, deal with all the traumas from overnight or during the day, and, if there was a gap in the traumas, we would try our best to deal with the subacute cases — the cases of patients who were just lingering on the floor, with broken bones, amputations, or conditions that never got operated on because there wasn't enough staff. We would just work until we couldn't anymore and then start again the next day. We brought anesthesia with us, every type of anesthesia drug we could, but we ran out. We had to choose who we would operate on and who we wouldn't. Who deserved, for lack of a better word, anesthesia, and who did not.
How did you make those difficult decisions regarding who received treatment?
It was very difficult to make those decisions, and it was a first for me. We would make judgments according to the type and severity of an injury and our resources. If they [were suffering from a condition or injury] that looked like we could not help, such as >75% burns on their body, which require a lot of antibiotics, fluids, and multiple operations for debridement, then we would often not operate, knowing they would pass in hours All the ventilators were infested with a very virulent, multi drug-resistant bug. I had to make medical decisions that were unsafe and that I wouldn't normally make to keep people off ventilators. I had to give people anesthetics that didn't provide full coverage, and they would have to feel pain during their operation because I had to triage my resources. These are all things that we didn't have access to. Every single day, until now, they're asking me, “How can I get these medications?” My anesthesiology peers from Gaza are really struggling. They're trying their best to get meds by contacting the field hospitals, such as the Emirati, to transfer drugs to them. They're not getting the care that any human deserves.
What was notable about the injuries you treated, and what might they say about the weapons being used?
I saw an endless amount of children as patients in the hospital. The most difficult were the burn cases. The [Israeli Occupation Forces] use thermobaric bombs. These are high-temperature bombs that were used in World War II. Thermobaric bombs have such high temperatures that they create extreme burns and also create a negative-pressure environment. It sucks all of the air out of anything around it. So all these kids would come in that looked like they had no injury, but then when we went to intubate, blood would pour out, and we would find that they had destroyed lungs and other organs. They look perfect on the outside, because the negative pressure sucks the air out of their lungs and destroys their organs. One night, I had a four-year-old patient; his body was 80% burned. Other than his sister, who also came in alongside him with injuries, they lost their entire family. The 4-year-old, Mahmoud, suffered from negative pressure injury to his lungs. When we went to intubate him, his lungs had imploded. He was coughing, dumping out blood. He died, and his 12-year-old sister was the sole survivor of the family. Another day, an 18-month-old was brought in with a gunshot wound to her head. Multiple young boys aged around nine to 20 years old came in with gunshot wounds to their joints. The joint is a highly targeted area because it's very difficult to provide prostheses for joint injuries. There is also a huge popliteal artery there, which is very difficult to repair, and if you bleed out from it, you'll likely die without the resources (which have been restricted to these patients). We saw a lot of gunshot wounds targeting the popliteal arteries behind the knee. These were the most common injuries, alongside pulmonary injuries from the negative pressure caused by the thermobaric bombs, and burns from the high temperature.
What was the shift that you witnessed in the hospital environment, among the patients, and also for yourselves when Rafah was invaded?
There was an immediate heightened sense of anxiety among the colleagues. Suddenly, everyone was asking us for suitcases so they could follow the instructions of the fallen leaflets and displace themselves. Hospital staff had to evacuate their families, their homes, and abandon their patients. One morning, I was devastated to hear about a baby who would otherwise have lived, but there was no pediatric ICU doctor on call because he had to flee the bombing with his family. The child just had RSV, a standard virus that kids have all the time, but the baby died because it couldn't be intubated. There wasn't any pediatric ICU doctor to treat him. Seeing people have to abandon their patients was very hard, and for a few days to a week, there was almost zero staff. Doctors, nurses, and general staff had to leave because they were being displaced. They had to evacuate their families, they could no longer come to the hospital, and on top of that, there was a higher volume of patients because of the invasion. We were working overtime, trying to keep these patients protected while navigating heightened stress regarding the potential invasion and evacuation of the hospital.
An image taken during the invasion of Rafah. Courtesy of Dr. Alia Kattan.
What did Gaza teach you?
Every time I reflect on my experience, I learn something new. When you are watching the genocide through the news coverage or a secondary source, it's very easy to compartmentalize, continue with your life, and ignore an entire population. But having gone and being there, it's impossible to ignore, even if I want to. It has made me realize that we're all truly connected. I don't think people outside of Gaza realize that if they pretend like we can just ignore an entire people and live in our bubble, it is going to have major consequences, whether it's on ourselves later, because we've ignored the political consequences of letting Israel and their allies get away with this, or on our children because we let a genocide happen without trying to stop it. Our children are watching us, and they learn priorities and our responses to an active genocide in front of our eyes. We'll then have a generation of human beings who don't care about anything happening in the rest of the world. The hardest part about going was that we had the option to leave, while Gazans do not. They have to continue facing death, and we don't. It's very easy to underestimatethe magnitude of that feeling when you're not there, but having been there, experiencing it, and walking away, the fact that my passport and where I was born gives me the privilege of the basic human rights to safety, water, food and health care — that stays with me. I feel a major responsibility and fear forgetting or ignoring that.
Children displaced at EGH. Image courtesy of Dr. Alia Kattan.
What final advice can you offer to anyone who is reading your testimony and trying to gain a better understanding of the medical situation on the ground in Gaza?
I think that it's very easy to dehumanize Palestinians in Gaza, even if you are trying your best not to. We see the same thing over and over again, the numbers of morbidity and mortality are so high, and the war crimes get worse and worse. But I think it's really important to remember that they are just like you and me. They want to live. Everyone puts Palestinians in Gaza on a pedestal. People will say, ‘They're a chosen people. They're so resilient, they're so amazing, they're so intelligent, etc.' But they want, just like you and me, to go to bed at night without wondering if they will wake up. They want their kids to learn to read and to have an education, and to grow. They have all the same desires as we do, and they're suffering. And yes, they are amazing people, and they're stronger than us, but it doesn't mean that they are not feeling those same things. I think that often gets lost in the news, or the volume and severity of death and destruction. For anybody who wants to make a difference, it's going to take self-sacrifice. I'm not a politician. I'm not a lawyer. But I do know the road to becoming a humanitarian. I do know how to provide medicine. I do know how to provide education. When we returned, we started a nonprofit, where we work with Gazans to provide basic needs like water, food, and education. Whether it is through boycotting, taking the time to educate others, or putting your career on the line, your life cannot go on as normal without change. I think some people don't realize that if they want to see change, it's going to take some amount of self-sacrifice, and everyone has a skill to provide if they just give what they are good at. There can be a change in small amounts. That has also been a beautiful thing that I've seen, how people are helping in the ways they are capable and how it makes a huge difference in even one child's or one family's life. People need to continue to focus on the cumulative impact of their actions, not futility.
*We reported about such restrictions previously, see: https://www.palestine-studies.org/en/node/1655910
**The Israeli regime declared Mawasi a so-called “safe zone” but has repeatedly bombed the area and the displaced Palestinians who sought refuge there.
