Reusing scalpels, operating with no anaesthesia: A doctor’s diary in Gaza

In Gaza today, scalpel blades have to be reused in surgeries, but that results in them becoming too blunt to do what they are supposed to do.

In Gaza today, medics often carry out surgical procedures without pain control.

In Gaza today, nearly all patients suffer from malnutrition, so their wounds do not heal.

The infection rate among patients is “beyond imagination”, Dr Riyadh Almasharqah, 54, told Al Jazeera.

The plastic and reconstructive surgeon said instruments are rarely sterilised, and patients usually stay in overcrowded wards.

This is all a result of a siege imposed by Israel, which has severely limited food and lifesaving medical supplies from entering Gaza.

Nothing works

Medical professionals – starving, exhausted and fearing for the safety of everyone around them – are struggling to help people in the handful of barely functional medical facilities left in the besieged Gaza Strip.

They get rare help in the form of medical missions from overseas which manage to get Israeli approval to enter Gaza, like the PalMed mission that saw Almasharqah spend two weeks working at the European Hospital, the only hospital functioning in southern and central Gaza.

“It’s a frustrating situation to describe fully. I mean, everything was difficult,” Almasharqah told Al Jazeera, working in the struggling Khan Younis hospital.

Six months into Israel’s deadly assault on Gaza, following the October 7 Hamas-led attacks on southern Israel, the lack of equipment, medicine, and supplies has pushed the medical sector closer to total collapse.

The situation has drastically worsened with famine-like conditions that have affected more than 90 percent of Gaza’s 2.3 million people – most of whom are now internally displaced.

A combination of the two means that simple reconstructive procedures, like skin grafts, become very difficult to do properly and, chances are, the patient’s malnourished state often means they will not heal properly.

In every scenario, essentials were lacking.

Add to that the medics’ fear of Israeli attacks and what was to Almasharqah an unimaginable volume of patients.

“Only in the orthopaedic [department] … at one time, there were 250 patients. In plastic surgery, there were 70 patients,” he said.

The procedures needed ranged from basic wound care to emergency surgeries, and even bigger surgeries that require reconstruction.

But “simple procedures become so … complicated in that atmosphere because the instruments are not working”, Almasharqah said.

‘Emotionally draining’

Palestinian families forced to flee their homes have sought shelter in and around hospitals since the start of Israel’s assault on Gaza.

However, most hospitals have come under attack and have been raided by Israeli forces, forcing thousands of wounded and displaced Palestinians to flee and putting facilities out of service.

Israeli attacks have destroyed more than 200 medical facilities, partially or completely. At least 32 hospitals have been put out of service.

Hundreds of displaced Palestinians, medical staff, and patients have been killed.

But with a lack of places to seek refuge, families still shelter in and around medical facilities, crowding hospital courtyards, hallways, and wards even more.

The situation makes finding a post-operative patient difficult, Almasharqah said, pointing out that follow-up is essential.

“All the wards are full, so they send them to a field hospital attached to the [main] hospital,” Almasharqah said.

“It was a challenge to find where the patient had gone, and whether they received the proper post-op treatment,” he said. This is also because there is a shortage of nurses and paramedics, he added.

Oftentimes, patients do not have access to the antibiotics or fluids required post-surgery.

“It’s an inhumane situation by all means,” Almasharqah said.

“Easily, more than 80 percent [of patients] were children and women, and they were badly injured. I cannot … describe their injuries and burns they sustained,” he said.

Almasharqah, a father of six himself, lost three child patients to burn wounds within 48 hours, despite his repeated pleas that they be transported out of Gaza for treatment.

“No … action was taken,” he said. “I was approached by a number of charities, and they promised to do something, but I kept losing them, one by one.”

The first child was a little girl who had sustained about “50 percent burns”, he said. “We lost her because she was so cold and we were trying to keep her warm.”

According to the Ministry of Health in Gaza, Israel has killed more than 33,137 people and wounded some 75,815 others in Gaza since October 7.

Nearly a quarter of injuries are children, the ministry said.

Almasharqah said there are “countless memories” that will stay with him forever – from the sounds of bombardment to the sight of triage centres overflowing with patients and bodies.

“There were many faces I won’t forget, particularly the faces of innocent children shattered by war,” he said.

Yet the most memorable moments for Almasharqah were the children who “displayed incredible resilience despite their injuries”.

“Their bravery in the face of adversity was both heartbreaking and inspiring,” he said.

“I realised these people are so strong and they will never be defeated.”

Despite the immense levels of human suffering, Almasharqah said there were moments of “hope and positivity – whether it was saving a life or providing comfort to a patient in pain”.

“People were so grateful, he said. “They just want relief from pain.

“I will definitely go back again,” he said. “These people deserve better. They deserve all the help, all the care.”