Gaza’s crumbling healthcare system

The roof cave-in at Shifa was just the latest manifestation of Gaza’s ongoing health crisis [Ahmed Abdelall/Al Jazeera]
Gaza City – Zinat al-Jundi was in her bed in the maternity ward at Gaza’s al-Shifa hospital when chunks of cement and concrete began to fall on to a nearby bed, occupied by a mother who had just given birth.

“My roommate had just moved her baby to make the bed when a block of concrete fell, right where the baby was,” Jundi told Al Jazeera. “It was a miracle that we were not hurt.”

The debris fell into their room after the building’s concrete roof caved in last month, causing panic throughout the facility as it was evacuated in a hurry.

The incident, however, was far from unforeseen: Used daily by thousands of people, the 60-year-old building – part of the complex that makes up Shifa hospital – had long been showing signs of disrepair, as cracks crept into the walls and ceilings.

The roof cave-in at Shifa was just the latest manifestation of Gaza’s ongoing health crisis, as the besieged territory struggles to provide adequate care to its 1.8-million population.

Several Gaza Strip hospitals are six decades old. Nasser hospital, the main facility serving the southern Khan Younis district, was built under Egyptian rule in the late 1950s and named after Gamal Abdel Nasser, the former president.

Three of the five main buildings at Shifa are from the same era, and two are now collapsing: In addition to the obstetrics building, the internal medicine building was evacuated four months ago after engineers warned that a collapse was imminent.

The building housing Shifa’s maternity ward contained 93 beds and handled about 70 deliveries a day. Also in the building were a gynaecology ward, an outpatient clinic and a neonatal intensive care unit that received cases from throughout the Gaza Strip.

Two private hospitals in Gaza are now helping to manage the cases that otherwise would have been directed to Shifa.

Medhat Abbas, director general of the Shifa complex, told Al Jazeera that even before the cave-in, patients in the ward sometimes had to stay in the hallways due to overcrowding. Attempts were made to secure funding from international agencies for a new building, he said, but to no avail.

“We alerted everyone and provided situational updates,” Abbas said. “No one listened.”

Around $10m is needed to replace the two crumbling buildings at the Shifa complex, he added – but who would finance these projects remains unclear. Tens of thousands of former Hamas employees in Gaza have gone without their full salaries for months, and the consensus government in Ramallah has shied away from managing Gaza’s crises.

Even if funds were secured, progress could be further stalled by Israeli restrictions on building materials entering the territory.

Munther Ghazal, the managing surgeon at Shifa’s department of gynaecology and obstetrics, could not conceal his frustration at the situation.

“You cannot have patients, operation rooms and the neonatal ICU scattered at different areas across the city,” he told Al Jazeera. “This has to be temporary.”

The frailties of Gaza’s health sector are deep and diverse. One year ago, maintenance and cleaning companies went on strike after failing to receive their salaries, and the ensuing financial crunch forced hospitals to stop serving patients’ meals. Charity organisations stepped in to help fill the void.

Shifa’s old and rusty laundry machine stopped working more than a year ago, and since then, sheets, robes and gowns have to be carted 30km away each day to Nasser hospital for washing. Meanwhile, vacancies left by retiring employees have not been filled: For the past three years, there has been no significant, permanent recruitment in Gaza’s public sector.

Consequently, despite hundreds of vacancies, scores of newly graduated doctors, nurses, technicians and secretaries remain unemployed.

Subhi Skaik, medical director at the Shifa compound, estimates that the hospital runs with 20 percent less staff than it needs – and smaller hospitals are probably suffering more, he added.

Gaza’s health ministry and the Palestinian Medical Council, which oversees training programmes, has offered new graduates the chance to fill these vacancies without pay in exchange for experience certificates and the possibility of employment down the road.

Dozens of people have taken advantage of the programme but, with no permanent solution on the horizon, dozens more have emigrated or are seeking a chance to leave Gaza.

Movement restrictions have led to a further deterioration in the quality of services in Gaza, Skaik told Al Jazeera.

“Medical education is a continuous process. We need scholarships and delegate exchanges to update our knowledge and improve our skills and experience,” he said. “Dozens of doctors lost grants of higher education because they were not able to join their programmes in time … Nonetheless, we hold regular conferences and have resorted to online lectures with foreign experts and tutors.”

Several specialties, such as pediatric cardiac surgery and radiation therapy, are missing from Gaza hospitals altogether, either due to a lack of specialists or a lack of equipment, forcing patients to be transferred to Israel or the occupied West Bank.

Shifa’s Prince Nayef Oncology Centre, built in 2005 with a price tag of more than $5m, has yet to become operational due to an Israeli prohibition on equipment needed for radiotherapy and cancer diagnostics.

Jundi, the patient from Shifa’s maternity ward, said it is time for the government to step up: “I call on President Abu Mazen and everyone to save us … We have nowhere to go now.”


This content was originally posted here


Gaza’s second war: 5 Hours at Shifa


Monday, November 19th, 2012, was the fifth day of the war.  The number of casualties took a sharp increase in the past 24 hours, reaching more than 90 martyrs and 700 injuries, nearly doubling in 24 hours.  It was time for me to join the medical staff at Shifa hospital.  I made a few calls and the decision was taken: Two of my colleagues and I are going there.

Apart from few pedestrians, unable to find a taxi, the streets were empty.  Most of those in the street were heading to the same place, Shifa.

During my first hour at the hospital several delegations were arriving, visiting the hospital and conveying the support of their nations.  This was a huge change from the previous war in 2008, in which Gaza was left alone to face its destiny.  One of the delegations constituted of over than a hundred Egyptians; they were scholars, politicians, activists and journalists.  In the eyes of the visitors, there was neither fear nor pity, instead a feeling of honor and gratitude for the opportunity to visit Gaza.  “To the free world, Gaza has become a symbol of resistance.”, one of them said to me.  “We are visiting to get a glimpse at your glory being written.”,  he continued.

As the delegations were concluding their speeches and preparing to leave, we were preparing for a new wave of bombardment as the unofficial and incomplete halt of airstrikes ended with their departure.  Suddenly the sirens went on, several ambulances rushed out one after another.  They received information that drones had targeted a building and there were many casualties at the scene.  The target was ‘Al-Shorooq Tower’, which is located at the heart of Gaza city and on one of Gaza’s main streets.  It includes several media quarters in addition to residential apartments.

Despite my medical training,  I was worried about what I was about to witness; this was my first hospital duty in time of war.  War circumstances are nothing similar to those of regular medical practice.  I didn’t know what to expect.

Minutes later, the paramedics were rushing in with the first casualty.  It was a man who sustained large shrapnel, which penetrated his back and settled within the abdomen.  He was taken to the intensive care unit and a team started resuscitating him.  His injuries were critical.  Seconds later, another casualty was rushed into the ICU, a little girl under the age of eight whose face was covered with blood and she was unconscious.  Her injuries were directly to the head and she was in a critical condition, too.  A second team started working on her immediately.  They were racing with time to stop the bleeding as fast as possible to save her life, and fast enough to get ready to handle the other casualties coming on the way.  In the corner was a man in a sweater.  His face was expressionless, but his feet could barely support him.  He was the girl’s father.

Suddenly there was noise coming from outside.  I was heading towards the door of the ICU room when the door suddenly opened wide and a stretcher was pushed in.  A couple of seconds had to pass before I could realize that what looked like a black wooden sculpture was in fact the charred body of a martyr.  It was my first time to see such sights.  I could have collapsed like what two of journalists did immediately on the spot, but I was holding on.  I was inspecting the body as it was being taken to the morgue when the doctor besides me advised me not to look, “You’d better save your strength for later”, he said.  I believe he was right.

It is noteworthy that scenes of charred corpses and major deep burns were not uncommon in this war.  That raised serious debate among the medical society about the possibility of white phosphorus or other chemicals being used.  Until Gaza gets advanced techniques to investigate this matter, these debates will remain unsettled; and these weapons, whatever they were, are likely to be used again.

Back to the emergency room, dressings were in shortage and some types of sutures were missing. But there were few children who needed stitches which had to be done anyway.  The children’s parents used several approaches to keep them calm during the process, the youngest ones received money while the older ones were urged to be strong just like the resistance men.  Neither method was perfect but the second gained more success.  In such an atmosphere of resistance, even children participated in their own way.  Among all that was that doctor who hid a box of chocolate bars.  And whenever wounded children arrived, she would give them a bar or two.  It did not cheer up the crying children a lot, but certainly soothed the worried parent!  It is such simple gestures like this that actually make big differences.

Time quickly passed by.  It was getting dark and taxis were starting to disappear from the streets.  My two friends and I evaluated the situation fast and decided that we would go home for the night.  On the way home, the streets were completely deserted except from ambulances on the major crossings.  The only sounds were those of drones and the occasional explosions.

My short experience ended there, but up to date I keep thinking about the lessons I learned from it.  I keep thinking about how to many people, war casualties are nothing more than numbers in a fleeting tweet or a momentary breaking news.  About the families to whom loss of a member meant loss of the life as they knew it.  About the children who are never going to see their fathers, the wives who are going to raise their children alone and the mothers who never thought their sons will leave this world before them.  Yes, War is ugly, but its ugliness also drives out the best in people; the paramedics spending the night out in the open, the doctor with the chocolate box, the taxi driver who refused to take the fees, the minimarket owner who opened his shop despite the risk.  These are all examples of how everyone can make humble but significant contributions to their society in ways they did not think were important.  With these lessons and many others, my experience which lasted for a little over five hours affected me in many ways that will last forever.


A version of this article was published in The Lancet Student magazine on the 8th January 2013

It’s Complicated !

Man, motivated by his ego and lured by his apparent superiority, has always tried to distinguish himself from other beings. I was interested in this “dilemma” ,and while exploring the answers, I came across many definitions. Some said he was an animal which had the ability to think, others defined him by his ability to read, and yet others believed that man was different because he recognized the inevitability of death    .

These arguments made sense, but the last one in particular I found intriguing. In my opinion, it’s man’s understanding of this very basic fact which gives him his special qualities. When you’re aware of your own mortality and the fact that your time in this life is limited, you’ll try to make the best of this time to create, to develop, to enrich the world, to leave a clue that you were once here, and to achieve something which tells your successors that despite the fact that it’s unlikely that they’ll ever defeat death, it’s best if they die trying.

My opinion gained evidence during the first days of my service at the hospital. In there, I’ve seen many of the faces of death. I witnessed an old lady with a brain tumor taking her very last breaths. I saw a young man who suffered severe head injury which left him brain-dead, so he was basically alive without even knowing it. I saw and saw, and as I observed I couldn’t help but think about the instability of life, and how at a glimpse it could all turn upside down. At times, I would imagine suffering the same condition, and I would find myself thanking Allah for the current moments I’m living and feeling grateful for every second I have.  And there were incidences when I would drown into these thoughts and lose attachment to my surroundings only to come back to reality few minutes later when the doctor asks me a question or something.

The emotions were overwhelming; my reaction to such sights was immense. It was “Humane” and so was its impact. This affection was loading me with great well to do my best to relieve the pain for those who suffer. It seemed to me that this would be the print I’m leaving.

But as the days passed, they carried with them an unpleasant change. My strong reaction was fading; the affection is lessening! The compassion is still there, but it’s just not making the same influence. Patients were souls to be salvaged, and their complaints were stories to be told. They are now simply puzzles to be solved! I’ve come to realize this change lately, and I’ve been since confused, asking myself many questions: Does this make me any less of a human, a machine maybe? Were my concepts wrong at the first place? Or is this a normal human thing, an adaptation, a divine blessing which keeps the wheels going? If it is, is it supposed to happen this fast?! Would my fantasies about finding a cure for cancer fade eventually, too?

The first assumption was particularly irritating, and I wouldn’t even dare to consider it, but the rest weren’t any easier, too! All the questions are tough and the answers to them -once found- are disturbing. They all dig deep into my self-perception.

The quest for answers continues, but as it does, and although I know it actually may never end, part of me is now relieved because lately, I’ve come to realize that asking such questions is in itself part of being human, and this is an answer.