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 first interview, you can read the second interview here. 

TW: This article includes an image showing a leg being operated on, blood is visible. 

From the bombing of Al-Ahli Hospital to the siege of Al-Shifa Hospital, Israel has attacked more than 400 healthcare facilities and personnel, impacting essentially every hospital across Gaza. Over the past nine months, the systematic targeting of Gaza's healthcare sector and infrastructure reflects what Dr. Ghassan Abu Sittah describes as an Israeli “policy of creating disaster by dismantling all necessities of life.” A disaster that will continue long after the war ends. 

Since the start of the genocide, Israel has targeted hospitals and healthcare staff in Gaza, deliberately damaging or destroying medical facilities throughout the Strip. Israeli Occupation Forces created what the UN Human Rights Office spokesperson described as “a pattern of attacks… striking essential life-saving civilian infrastructure in Gaza, especially hospitals.”

This pattern of brutalization has fed into the creation of “disaster” and was exemplified by the May 6 Israeli ground invasion of Rafah, a city sheltering more than 1.4 million Palestinians. Despite repeated warnings and outcries from the international community and human rights organizations, as well as a July 19 UN International Court of Justice ruling calling for the end to Israel's illegal occupation of Palestinian territories, Israeli tanks continue to roll into the city as missiles repeatedly strike so-called ‘safe zones' and hospitals. 

With the assault on Rafah came the seizure of the Rafah border crossing, a crucial (and oftentimes only) site for escape and entry point for humanitarian aid. This seizure resulted in the entrapment of international medical staff, the reduction of an already limited supply of medical aid and hospital equipment, and the heightened spread of infectious diseases. It exacerbated an already dire situation, leaving hospitals without fuel and hundreds of thousands of people without food, water, or medicine. Essential medical services are dwindling due to evacuation orders, and medical staff are disappearing into Israel's shadowy detention labyrinth, leaving patients behind.

Beyond Rafah, referrals from neighboring hospitals overwhelmed the partially functional European Hospital in Khan Yunis. With its mere 200-bed capacity and a limited supply of anesthetics, antibiotics, and medicines, the European Hospital was struggling to provide care for the thousands of patients at its door. 

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. 

These examples illustrate the severe and ongoing impact of the genocide on Gaza's healthcare system. To further explore these challenges, Palestine Square spoke with Dr. Ali Elaydi, a Dallas-based Palestinian-American orthopedic surgeon from Gaza who traveled to the European Hospital in the Strip on a medical humanitarian mission with Fajr Scientific in April. The conversation focused on his experiences in Gaza, the efficacy of medical missions, and the weaponization of healthcare. 

This interview has been transcribed and edited for clarity and brevity. 

Could you tell us more about your motivations for going on the medical mission in April and what you were tasked to do? 

I was born in Gaza. Most of my extended family still lives in Gaza. Early on in the war, one of my cousins was shot in both of his legs, requiring multiple operations, and my aunt was killed in this war. 

My motivation for pursuing medicine has always been to help my people in Gaza. Once this war started, I knew I had to do something. It was very difficult to sit back and watch, and I felt like all those years I put into my career in medicine needed to pay off. 

The organization that I went with, Fajr Scientific, is mainly an orthopedic surgery group. The mission of the trip was to bring supplies to operate and to help develop a long-term strategy for what we could do in Gaza. We envisioned bringing in enough orthopedic supplies to set up for future missions. The mission I joined was the organization's first mission in the aftermath of Oct. 7. We anticipated operating, bringing in supplies, and helping feed the population of Gaza. That was also very important for us. With the support of various donations, we supplied about 500 meals a day for the forcibly displaced during the time we were there.

Dr. Elaydi is seen operating on a patient with other colleagues in Gaza at the European General Hospital in April 2024. Photo courtesy of Dr. Elaydi. 

I always wonder about how medical missions, especially short-term ones like two-week relief efforts, potentially cause more harm in the long run. It's good to hear that the organization you went with seems to have considered these ethical issues before going. For instance, I noticed on your social media that you all had suitcases packed with medicines you were taking across the border. 

We were essentially told to prepare as if we were operating in a desert. We brought everything that we expected to need: medications, hardware, surgical supplies, personal protective equipment (PPE), gowns, drapes, etc. It was really important that we add to the overall resources in Gaza rather than simply utilize them. We even brought our own food and water. 

I think the intention to help is always there, but when you're there for just two weeks without a long-term plan, you can fall into the trap of doing more harm than good. So it was important for us to make sure that there would be follow-up by physicians in succeeding medical missions and long-term outcomes for our treatments. 

One of our mission's immediate goals was to relieve the Gazan healthcare force, who have been working for months with no pay and little to no rest. We tried to take over surgeries to give them as many breaks as we could.

I'm sure you, like all of us, have been inundated with footage coming out of Gaza of the genocide since October. I'm curious about the reality of working in a warzone compared to what we see on social media. What did you see? 

One of the hardest things for me was to see the images coming out of Gaza, to see the destruction. Often, I was unable to even look at the pictures. I do think it's important to show what's happening on social media, but I struggled to see it.

So I mentally prepared myself for an extremely difficult experience. I have a background in medicine and received all my training at a large Level 1 Trauma Center, so I've seen a lot. But this was completely different. This was my home. A lot of the death and destruction was completely preventable. It was extremely difficult seeing it all up close and on such a wide scale. Seeing just how helpless a lot of the families felt. I also often felt just as helpless and powerless: like I was not doing enough, but I also didn't know how to do more. 

Despite being involved in several surgeries during the mission that hopefully helped around thirty to forty people, the reality of the war was that everything I did could be undone in a single bombing, a single airstrike. The work that we did, as doctors, could be totally destroyed. I realized that while we could set up medical missions and perform surgeries, the only way to preserve innocent lives is to stop the war. The only way to truly help the people of Gaza is to stop [killing them]. 

Can you describe what your day typically looked like?

There were 15 of us on the mission. We slept in a safehouse with one working bathroom. Once we were ready for work, we would call over to the UN so we could start making our way to the hospital. Then the UN would call the Israeli military to coordinate a “safe” route for us to get to the hospital. In the meantime, we waited until we got a call back for approval, which sometimes took thirty minutes, sometimes hours. Once we were on the route, at a pre-established halfway point, we would call again for Israeli military approval before continuing the rest of the way. Often, we would have to wait another thirty minutes to an hour before we were approved to continue the rest of the route. The whole process of getting to the hospital would take anywhere from an hour to two hours, but the hospital was less than a ten-minute drive from the safehouse. 

Once we reached the hospital, we would immediately see the thousands of people who were sleeping and living on the compound. We made our rounds and started our work. We would first try to plan the night before, see which cases needed immediate attention, and prepare the four Operation Rooms (OR) for the day's schedule. There were a number of teams from my organization and other organizations, and we would divide ourselves amongst the ORs, with about two surgeons per room for efficiency. In between cases, I would run down to the emergency department and triage the patients.  

We would roughly get to about three to four operations a day. My team ended up staying and sleeping at the hospital because we could only leave at 5:00 p.m. If we left after 5:00 p.m, the Israeli military would not approve a safe route for us, so we stayed and worked until 1:00 or 2:00 a.m. Then, between the thousands of people sleeping at the hospital, we'd look for a place to sleep on the floor, and if we were lucky, we'd find one and maybe even a blanket. 

And what were some of these cases that you worked on? 

We dealt with a lot of gunshot wounds, some blast injuries from bombings, and some previous trauma that hadn't been taken care of yet. One of the cases was a 45-year-old man named Ma'en who had a month-old spinal fracture. He became paralyzed because the injury was left untreated for so long. His spine needed to be stabilized immediately after the injury. 

One of the things we had to deal with was how much of our resources we utilized toward acute trauma versus the overall health of the population. There was acute trauma happening all around us, but people were still getting sick and people still needed routine orthopedic care. We had a case where a baby had developmental hip dysplasia, and that's something you need to cast from a young age, or else the hip socket would never develop. This is something that you have to do within the first couple months of an impacted child's life or else it would be very difficult to treat later down the road. We treated him, while also triaging similar cases with the acute trauma that was happening.

Dr. Elaydi speaks to his patient, Ma'en, who became paralyzed due to an untreated spinal fracture. Photo courtesy of Dr. Elaydi.

When it comes to routine care versus acute trauma, I want to ask specifically about the staggering number of amputations we're seeing now in Gaza. UNICEF estimates that thousands of children in Gaza have become amputees and Dr. Abu Sitta describes the situation as “the biggest cohort of pediatric amputees in history.” As an orthopedic surgeon, can you speak to the scale of amputations you've witnessed and a bit into what goes into the decision to amputate? How is it different from non-war settings?

It's 100% different. In my training, I've never had to amputate a child. Where I trained, I was taught that you do everything you can to save the limb, especially for a child. However, Gaza doesn't have the resources to do so. The hospital where I worked and trained at in the United States had a great limb salvage program. We worked with vascular surgeons and plastic surgeons to make sure that we did everything we could to save the limb. But there's no way we have access to all those resources in Gaza, during a war, and as a result, there is essentially no limb salvage protocol. This is something I had to learn and understand. We would work as a team to develop the best plan of action based on what we had available, and that unfortunately, does result in a lot of amputations. It's a sad, sad reality. 

We do know that children who do have amputations end up being extremely functional, based on the literature. However, in an abnormal setting like genocide, there is no room or resources to develop and nurture this functionality. As a result, you have a seven-year-old child who lost his right leg and has a broken femur on his left, and a broken jaw from a bomb injury. 

As healthcare workers, we try to make the best decisions for our patients. But in war settings, you also have to realize that you are constrained in your resources. Sometimes trying to save a leg is overall extremely hurtful to the patient, and without proper care can lead to infection and even loss of life. 

While amputations may be the best decision given the circumstances, it's also overwhelming to think of the cascade of consequences children who undergo amputations face. According to clinical studies, young survivors of amputations need somewhere between eight to twelve follow-up surgeries, as well as new prosthetics multiple times a year before they reach adulthood. This is not taking into account the psychological impact and support that they require. How did you manage postoperative care and rehabilitation in a setting where follow-up is challenging, or even, perhaps, impossible? 

Unfortunately, even the thought of rehab is not in the discussion right now. The system is so overburdened that even the acute trauma isn't being treated. We have trouble getting food into Gaza, let alone prosthetics. We know that rehabilitation for these children is going to be a long-term process. Prosthetics are expensive and they are going to need multiple prosthetics. But right now, the major concern is treating the immediate issues and trying to preserve life. It's been months since the start of the war, and rehabilitation should have started right away. But these children also should be eating. 

We know so little about the weapon systems currently being used in Gaza. As someone who has treated victims of these weapons, could you tell us how your patients' wounds and injuries could provide you with insight or more information into the types of weapons being used and what were some of these weapons? 

I saw many bilateral lower extremity injuries, or injuries that affect both legs, caused by high-caliber weapons. These were not the low-caliber gunshot wounds I was used to seeing. These were kids being shot in both of their legs with large-diameter projectiles resulting in retained bullets in the limbs. For instance, we would have four to five bilateral tibia fractures a day. That means people with broken or cracked tibias on both legs from these weapons. It was very obvious the Israelis were shooting to prevent people from walking. 

We also saw blast injuries from bombings and burns. One of the emergency medicine physicians that I met showed me images of the white phosphorus burns he was treating. This use of white phosphorus is illegal under international law. It is also extremely difficult, almost impossible, to treat, even with a wound care specialist. A lot of these white phosphorus victims were children. Their burns can lead to further infections, and there was just not much that we could do. 

But I do think that the main thing that we can do as doctors is document these things. There are only so many patients we can treat, unfortunately. But the biggest thing that we can do is use our voice and document what's happening and show the world what we are seeing.  

Medical professionals are often uniquely positioned to bear witness to atrocities. Could you expand on what role you believe medical professionals have in witnessing, documenting, and testifying about these atrocities? How do you reconcile the immediate need to care for your patients with the broader implications of documenting and reporting human rights violations? 

I would say Dr. Ghassan Abu Sitta is one of the biggest inspirations and one of the most outspoken medical workers when it comes to documenting and testifying. Dr. Abu Sittah often speaks directly to what he witnessed in Gaza. I think this is extremely important because our understanding of what's happening is different than the average person. With our training, we see things differently. We can help document the atrocities that we're witnessing. 

While I was in Gaza, the one thing people kept telling me was, “Don't forget about us. Tell our story. Don't let the world forget about us.” And that's the saddest thing — that they do feel forgotten about. But we all have a duty to speak up. We all have a duty to inform and to educate. 

We know that since October, the Israeli military has repeatedly, and disproportionately targeted the entire healthcare infrastructure in Gaza. This includes attacks on medical facilities and personnel, systematically destroying the health system. Al Shifa Hospital, the largest medical complex in Gaza was completely destroyed after a two-week raid by the Israeli military. Mass graves held evidence of a massacre of patients and hospital staff with their hands tied behind their backs. Doctors have been disappeared, detained, tortured, and even killed. Israeli airstrikes have targeted medical residential compounds. Unfortunately, the list goes on, but can you describe the psychological and social effects this weaponization of healthcare has on civilians and medical staff? 

One thing that we know is that this has never been done before. They are setting a dangerous precedent. 

We treated an injured doctor who was a surgeon at Al Shifa Hospital during the raid [18 March 2024- 1 April 2024]. His story is one of the most heartbreaking stories I've heard. He was an orthopedic surgeon, operating in his OR when Israeli Occupation Forces walked into his operating room and demanded that he stop. When he refused, they shot him in the legs and then broke his eye socket with the butt of a gun. He, unfortunately, passed away in May as a result of his injuries. 

At the European Hospital, where I was working, we all feared our hospital would suffer the same fate as Al-Shifa. 

I think what Israel is doing is calculated. They're destroying any ability for Gaza to prosper. They're going after our factories, schools, universities, and hospitals to make life literally impossible. When you destroy the infrastructure, when you destroy the educational system, you not only destroy the present, but you also destroy the ability to rebuild, you destroy the future. 

Photo of destruction in Gaza. Courtesy of Dr. Elaydi.

To expand on that notion of rebuilding; Dr. Ghassan Abu Sittah writes, “Part of our resistance to the finality of genocide is for us to talk about tomorrow, plan for tomorrow, work on healing the wounds of our people. The aim of this war is that there would be no Palestinian tomorrow. We own tomorrow. Tomorrow is a Palestinian day.” As a Doctor, a Palestinian, and a Gazan, what does tomorrow look like for you? 

That's a tough question. I recently took part in a conference in Jordan about rebuilding the healthcare sector in Gaza, and that's actually where I met Dr. Abu Sittah. During that conference, one of the presidents of Al-Nassar Hospital called in via Zoom, and with such sadness, I remember him saying, “How are we talking about rebuilding when we are still dying.” That's the unfortunate reality. Yes, we do want to rebuild. We need to rebuild. But before we can even start discussing that, we need to stop the war, stop the death, and stop the destruction. We can't plan for reconstruction while things are still being destroyed. 

On one of my last days in Gaza during my mission, I traveled with my family to the North of the Strip. It was there that I saw the true extent of the destruction. I remember constantly pulling out my phone to record everything and my uncle saying to me, “Ali, stop recording, you're going to get tired. It all looks the same.” Entire neighborhoods were leveled; buildings completely destroyed. I said to him, “How can we rebuild this?” And he replied, “The Palestinians can do it in a year.” That's the hope I hold onto.