I Was in Gaza. I Had to Saw a Child's Bone Without Proper Anesthetic

I'm an orthopedic surgery resident in Houston, Texas, but I'm from Gaza originally and so is my family.

I went with a group of other surgeons and anesthesiologists to Gaza to provide medical aid, perform surgery, and consult patients in the emergency department. We just wanted to help as much as we could.

I entered Gaza on April 3, around two days after the World Central Kitchen incident, and was primarily at the European Hospital in Khan Younis, but also spent time in Rafah.

Daily life during my time there was nonstop. There was always something to do, someone who needed help. At one point I spent around 48 hours working constantly without a break or sleep.

I was either down in the emergency room because mass casualties had come in, jumping into the operating rooms all night long, or just responding to whatever disaster was happening.

We saw a lot of ballistic injuries, sniper injuries, gunshot and explosives wounds, and burns. We also saw lots of traumatic amputations: Crush injuries from people under fallen concrete or knocked-down houses.

We witnessed a lot of chronic orthopedic injuries that were not managed acutely, resulting in complex pathology that required complex treatment. We saw some very late-stage complications as a result.

And we saw chronic medical conditions like infections that had been developing for months and months. So something that would have been a simple fix like a diabetic foot ulcer was ultimately forming a systemic complex type infection requiring amputations, systemic infection, and multiple operative debridement.

The majority of patients we saw were women and young children, followed by elderly and then middle-aged men.

It was Ramadan while we were there, so we were operating in an environment with especially limited food and water. We couldn't sleep restfully at night because of the ceaseless bombs, both at the hospital and at our supposed safe house.

Nothing that we really needed was available; antibiotics, fluids, pain medication, anesthetics, orthopedic implants to be able to do the correct type of surgery. Everything was in shortage, missing, or disorganized.

We were dealing with a system with a 200-bed hospital housing 35,000 refugees. Trying to navigate that system with no pagers, no communication, and no way to consult other services or anything of the like—it was nothing short of chaos.

I'm still processing everything. It's the most difficult experience I've ever had. A heavy survivor's guilt accompanied us as we were leaving Gaza and plagues us today.

Seeing so much death and destruction, and children with amputated arms and legs, you just didn't really have enough time to process it there.

If you had maybe a minute or two to cry, you then had to get ready to see the next patient coming in. Otherwise, no one else was going to see them or take them to the operating room.

Two patients stick out in my mind. One was a six-year-old boy who came in the day we arrived. His house was hit by an airstrike back in November. He lost his siblings and his mother, and a very large fragment infiltrated his medial thigh.

It was in a particularly dangerous area of the thigh where lots of blood vessels run. From November to April, the boy wasn't able to walk or run or play, and was in exceeding amounts of pain. He would beg for anyone to take the fragment out.

This had been his life for five months. I was the only person who had the time to take care of the problem for him. I was in awe. It wasn't that difficult, but because of the constant barrage of life-saving surgery, there wasn't time to do it.

We did it with the boy awake in pain and limited analgesia. I had to use some lidocaine to help him push through the pain while I got it out.

Now I'm getting videos of him jumping and running, and it gives me a sense of tearful, pained joy.

Another story that stays with me, and I still cry when I think of it, is a 12-year-old boy who came in with both legs amputated from an explosion. The child was suffering severe burns; his arteries were bleeding all over and he was losing a lot of blood.

Over there, they don't have much blood to donate. The EMS had to use some rope as a tourniquet. The boy had to endure his surgery with very little anesthesia.

My colleague Dr. Junaid Sultan, a vascular surgeon from the U.K., took part in his care. Trying to explain to a little boy that you are using a saw to cut through his bone without being able to justify why you can't put him to sleep or take away the pain is immensely distressing.

In the West, children typically go into a recovery room after surgery to meet their parents who are picking them up. For a lot of these kids in Gaza, there was no one to pick them up after surgery. Sometimes they'd get lucky and an uncle would come, or a neighbor.

But oftentimes no one would. That's not something any of us really expected.

I was quite surprised by the morale of the Gazan people and the hospital staff. Almost half of the original hospital staff were killed during the conflict, and a quarter had fled during the war.

The few who remained were not getting paid and essentially lived at the hospital. But they had smiles on their faces and they had a willingness to work that I had not previously seen in my life. It made a lot of them my heroes.

I'm still in contact with a lot of staff from the hospital today. Even with the current invasion of Rafah, a lot of them are holding their ground because they know the European Hospital is the last stronghold for health care.

It's reserved for the 1.5 million people living down south in the Gaza Strip, and so their stance is: We are here, we are not leaving, and we are going to take care of any sick people who come in.

And that altruism is something that I still can't fathom.

I was in Gaza when the al-Shifa hospital was burnt down. A lot of the patients and doctors were coming down into the European Hospital, and they exhibited the same level of altruism that I couldn't believe.

The team that I went with in April was under an organization called FAJR Scientific, a U.S.-based NGO. We sent our second team at the beginning of May and they are in the European Hospital at the moment.

They are unable to exit and are operating in dire circumstances. Since personally being in Rafah and Khan Younis, I saw how fragile everything is, how there's no place for these people to go.

I'm beside myself with anxiety at the imminent cost of human life this offensive will lead to and the potential destruction of what remains of the health care system, especially if anything were to happen to the European Hospital, which would decimate the last remaining healthcare stronghold in Gaza.

When I exited Gaza, I flew to Germany for my layover before I went back to the United States. When I went through airport security, and they swiped my possessions, everything tested positive for explosive material.

That's because of how much of it there is in the air in Gaza; carcinogens, asbestos, TNT. The results of the toxicity in the air are going to permeate the region for decades to come.

But I want to go back. I would go back tomorrow if I had the chance.

This isn't just my sentiment, my lifelong brothers from the first mission like Drs. Ali Elaydi, Umar Burney, Adeel Khaleel, Aasif Kazi, Irfan Ali, or any one of the 13 members would be more than happy to answer the call.

Abdullah Ghali is an orthopedic surgery resident in Houston, Texas. He spent time delivering medical aid and providing health care in Gaza in April 2024.

All views expressed are the author's own.

As told to Shane Croucher.

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