When Feroze Sidhwa, a 42-year-old trauma and critical-care surgeon at San Joaquin General Hospital in Northern California, signed up for a medical mission to work in a hospital in Gaza for two weeks, he knew he would have to take his own medical supplies. So he travelled with about 750lb of luggage on his British Airways flights from San Francisco to Heathrow and onward to Cairo. Everyone in his group took “tons of stuff”: a colleague, Mark Perlmutter, an orthopaedic surgeon, took hundreds of pounds of orthopaedic implants.
The mission went to Gaza with the World Health Organisation; the call for volunteers was distributed by the Society for Critical Care Medicine, which is how Sidhwa found out about it. He has degrees from the University of Texas and the Harvard TH Chan School of Public Health. His father was born in Karachi, Pakistan, a few months before the Partition, and his mother was also born there, two years later. They are Parsis.
The European Hospital in Khan Yunis, in the south of the Strip, Sidhwa told me in an interview on 30 July, was considered to be the best hospital in Gaza. Yet what he found on arrival was a disaster: in terms of medical supplies, “what we took is what we had access to”. As Sidhwa found out in phone calls with doctors who had travelled to Khan Yunis before him, even basic supplies were unavailable at the hospital. There was no gauze, soap or syringes. “So, when I was getting ready to go, I started collecting supplies,” the Houston-born doctor said. “I put a thing on Facebook, saying: if you want to support the trip, here is a little Amazon wish list. And people actually donated huge amounts of stuff, more than I could actually take in the end, which was amazing.”
Donations included such supplies as syringes, needles, Xeroform gauze, sutures, colostomy equipment, scalpels and tape for dressings, among other items. People also donated money – about $25,000, which Sidhwa passed on to the United Nations’ relief organisation UNRWA. About half of the donations came from people he had never met, many of them Jewish.
Sidhwa arrived in Gaza on 25 March and left the Strip on 8 April. All the members of his medical mission have recurring nightmares about their time there. When asked about his dreams, Sidhwa said: “I do have dreams about kids being killed and their moms are screaming, but they’re not actually nightmares, if that makes any sense. I’m not freaking out when I wake up.” He still feels that he abandoned the people of Gaza when his mission ended. And so he brought together a group of 44 medical colleagues who have also volunteered to work in Gaza since Hamas’s initial attack on Israel on 7 October last year, and together they wrote to the Biden administration recounting what they saw in the Strip. The letter was published online and circulated on X/Twitter on 25 July.
The European Hospital was emptied in early July, after evacuation orders issued by the Israel Defense Forces (IDF). In May, the IDF took control of the Rafah crossing from Egypt into Gaza, which Sidhwa and his group had used to enter the Strip. Since then, medical volunteers have had to fly to Amman in Jordan, and enter Gaza from Israel instead of Egypt – crossing from Jordan via the West Bank, and on through Israel to Kerem Shalom, a border crossing linking Gaza and Israel. Doctors and nurses are allowed to take only personal belongings. “If you bring prescription medications that don’t specifically have your name on them, they’ll take them away,” Sidhwa told me. “You can’t take surgical equipment. You can’t take anything of use. You can only take your personal effects, your clothes, your toiletries, and that’s it. They even limit you to three kilos of food. I took four kilos of peanuts alone. I ate all of them and I still lost 15lb in two weeks.”
According to Sidhwa, Israeli authorities have imposed one other major restriction: no doctor or nurse of Palestinian descent can join a medical mission to Gaza. “If you are an American citizen or a citizen of the European Union but you are Palestinian, you can’t go. Israeli authorities will bar them. The WHO [World Health Organisation] has now actually sent out emails saying those of Palestinian descent should not apply, just because it’s useless.”
While Sidhwa was in Gaza, the European Hospital never came under direct attack, but bombing in the surrounding area was “continuous”. He lived in a room at ground level in an outlying area of the hospital; it used to be a Covid isolation ward, had been built as a separate structure. Every few minutes Sidhwa would feel the ground beneath the hospital shake. A strike knocked him out of bed one night. The only day when there was a break in the bombing and the drones disappeared from the sky above the Strip was 1 April – the day an IDF strike hit a World Central Kitchen convoy leaving a warehouse in Deir al-Balah in central Gaza, killing seven aid workers.
Bruno Maçães: Gaza was a hard place to be even for you, a Western doctor. How hard is it for the children who are there?
Feroze Sidhwa: There are multiple aspects to [the hardship]. But one of them is the way in which a lot of these children have died. Most of them have been killed in explosions where a lot of them would have been trapped under rubble. Some of them are going to die immediately from a concrete block hitting their head or something like that. But a lot of them have just had their leg pinned under the rubble, and because there’s no heavy moving equipment, there’s no way to get to them; they’ve slowly died of sepsis while buried in this dark tomb alone, freezing during the night, boiling during the day. And this would have taken days for each one of them. [It would take] three, four, five days for them to die in this way. It’s horrific to think of the scale of the suffering.
The ones that survive [explosions] are the ones that we saw. There was a little girl named Juri. She’s this thin little girl. She’s obviously malnourished. She has been her entire life. She’s got necrotic skin on her face from the explosion that ripped part of the skin off; her buttocks are flayed open. Her left leg is missing, like two inches of its femur. Her sciatic nerve’s been cut in half. She’s got maggots falling out of her wounds. It’s horrendous, what is happening to some of these kids.
Somebody might say, it’s war and in war, bad things happen. Children are certainly going to get hurt in a war. That’s understandable. Nevertheless, it’s not exactly clear why these particular munitions have to be dropped on these particular houses. But leaving that aside, it certainly doesn’t explain the children who were shot. And that was a constant issue that we dealt with. We had kids shot in the chest and shot in the head – in other words, clearly deliberate, clearly targeted [since the assault on Gaza began, Israeli authorities have denied that civilians have been deliberately targeted].
When I was writing this letter to the [Biden] administration, I talked to somebody who had been at a different hospital, in a different two-week period, and I asked, “How many kids did you see [who had been] shot?” And he was like, “All the time. Every day, kids were coming in [who had been] shot in the head and chest.” Everyone saw the same thing. It didn’t matter which hospital they [worked at], it didn’t matter when – they all saw the same thing. I was really shocked by that.
BM: Young children?
FS: Yes, I’m not talking about 17-and-a-half-year-olds. I’m talking about pre-teen children, young kids, small kids, kids with small heads, small chests. They all died. When military hardware hits a kid, it goes through a kid’s brain. I can think of one who survived. She actually had two gunshot wounds to the head, but they were both graze wounds. They were actually the only graze wounds I remember seeing.
BM: I assume you didn’t see the shootings themselves?
FS: No.
BM: But having seen so many cases, your opinion is that these are deliberate shots to kill children, rather than crossfire of some kind? This cannot be seen as conclusive evidence, of course, but what would the predominance of gunshot wounds to children’s heads and chests be as opposed to, say, wounds to the limbs?
FS: I don’t recall ever seeing a child shot in the limb, in the arm, in the leg. The only graze wound, or seemingly incidental wound, that I saw was that little girl with two graze wounds to the head and one [with a gunshot wound] in the lower ribcage. Every single other one that I saw was shot in the head or in the chest. It seems that if they were getting caught in the crossfire, you would assume that their body would be kind of hit randomly.
BM: In those two weeks, how many children shot to the head or chest would you say you saw?
FS: It was more than one a day on average… There might have been one or two days where I didn’t see a new one – but there were plenty of days where there was more than one, sometimes two siblings shot in the head because they were both outside playing at the same time.
[After our interview, Sidhwa reread the contemporaneous journal he kept while in Gaza and confirmed that during his two weeks there he saw 13 children who had been shot in the head or chest. The letter he and his colleagues sent to the Biden administration asserts that “every one of us on a daily basis treated pre-teen children who were shot in the head and chest.”]
BM: Is it possible that children who were killed with shots to the head or the chest might not have been brought to the hospital at all?
FS: Yes. A bullet that’s meant to penetrate armour [hits a kid]? The kid’s just not going to have a head. The EMS [emergency medical service] is going to find him and say, “There’s no reason to bring this kid to the hospital. We’ll just take them straight to the morgue.” And even then, very young children who are shot with normal bullets in their heads, it’s going to be so obvious that they’re dead that even their parents probably won’t tell [the EMS] to take them to the hospital.
BM: How acute was malnutrition when you were there?
FS: When I was there, the south [of Gaza] was much better off than the north. Now the situation is kind of equalising – because the south is getting worse, not because the north is getting better. But even in the south, malnutrition was a serious problem. Almost every single wound we saw got infected. Let me put it differently. Almost every single wound that we saw in an emergency situation – like when somebody came in and needed an operation right away – they all got infected. And the reason was the hospital was filthy. But if I take you and do surgery on you at the Gaza European Hospital, your wounds will heal fine, because you’re not malnourished.
A nurse practitioner reached out to me and she said: “Every day, for the two weeks I was there, I saw infants who had been born healthy, returned to the hospital so dehydrated and malnourished that they died.” And the reason is their mothers are so malnourished that they can’t breastfeed. There’s no formula in Gaza. Even if there were, you’re mixing it with [contaminated] water. We’ve all had to watch malnourished mothers mix infant formula with what they knew was poisonous water, and then feed it to their kids, because there was no other option. And that was if they got lucky enough to find formula.
BM: The Hamas-run health ministry in Gaza has now declared a polio epidemic. How dangerous can this be?
FS: Diarrhoeal diseases are 25 times [higher than] their normal rate in Gaza right now; bloody diarrhoea is also at a much, much higher level than it normally is. I never saw a kid squat and not have diarrhoea. Every single one did. Every single young child had a cough – 100 per cent of them. In literally – and I mean literally – every single room of the hospital, you would find family members of patients that had jaundiced eyes, which in this setting, almost certainly means they have hepatitis A. There’s just no way of diagnosing it right now. There’s no laboratory and no equipment available. These epidemics are raging right now.
One thing to remember is Gaza’s population is very well vaccinated. It’s a very health-conscious population. When the news of polio virus in stool samples from the sewage system was broadcast, the Israeli military said it doesn’t matter, because 95 per cent of Gazans are vaccinated against polio. But that’s not at all how the human body works. When you’re malnourished, your immune system doesn’t work. It doesn’t matter if you’ve been vaccinated against something or not. So, it doesn’t matter if your immune system remembers how to make antibodies against the polio virus. It’s not going to do it anyway.
BM: Is it correct to say children suffer the most in Gaza?
FS: This starvation campaign is primarily killing small children. [Humanitarian organisations including Human Rights Watch have accused Israel of using starvation as a military strategy, a claim Israeli authorities have denied.] They are the most vulnerable people. Pregnant women are a close second. Newborns are the worst off, and it’s really a horrendous situation. The deaths that this nurse talked about? Not one of them has made it to the news.
On one of my last days there, to give you an example, a brother and a sister arrived at the hospital. This was Rafif and Rafiq. Rafif was the younger sister. She was 13. Her right foot had been amputated, her right tibia, the lower bone in the in the leg, had an external fixator on it – the metal pins that stabilise across a bone while it’s healing. And she had a non-healing ulcer on the amputation stump. Her eyes were sunken. She was thin, but she was awake, she was coherent. It was clear that if she had access to nutrient-rich food and proper surgical care, then she could do well. She could recover.
But her brother was a very different matter. He looked like he had been locked in a basement by himself for weeks – that’s how thin he was. His ribcage was exposed, he had wounds on his buttocks that had never healed because he was so malnourished. His hair was falling out. His eyes were so sunken that he looked like they were bulging out of his head. He was completely incoherent. He had no idea where he was. He shrieked in terror any time somebody touched him. He didn’t recognise his own family members. The way we would say this in medical terms is he was so malnourished that he was in multi-organ dysfunction, multi-organ failure. His brain was not working properly, his skin wasn’t working properly, his bone marrow probably wasn’t working properly. We asked the hospital [administrators] to please admit him for feeding, because what he needed was a tube put down his nose [and have] nutrients pumped into his stomach. And the hospital said, “We don’t even have these tubes.”
I looked it up when I got back. These tubes cost $11 each. And so we told his family: go try to find food. But we knew we were giving them false hope. He certainly died.
At the end of the interview I asked Sidhwa about his recollections of the moments entering Gaza and his feelings when he left. He had eight large, heavy bags going in, but the Egyptian soldiers asked few questions. They scanned them for weapons and explosives and then waved them through.
Once inside Gaza, the first thing to do is deconflict – to coordinate your movements to minimise the risk of being caught up in a military action. Sidhwa’s group was travelling up the Salah al-Din Road, the main highway that runs through the Strip from north to south and connects all of its towns. “You have to request deconfliction of that route. You then just sort of sit there and wait, and then all of a sudden – it’s a smartphone app – the route turns green and you have to tell your drivers to floor it, because you only have 15 minutes.”
When the group arrived at the European Hospital, they witnessed the 10,000-15,000 people who were sheltering in its grounds. Sidhwa explained that his two weeks there were “physically miserable”, even for someone who is in good shape and in his early forties. He thinks a month would be too much to ask of Western volunteers.
For Sidhwa, there was no feeling of relief at the end of his mission. He felt as though he had betrayed the people in Gaza. “I know it doesn’t make any sense, but it’s how you feel.” On their first night after leaving the Strip, the group stayed in Cairo. Accompanied by Waleed, an anaesthesiologist who is Egyptian and grew up in the capital, Sidhwa went out in the city that evening: “We all ate more food than we had eaten the entire time we were in Gaza. And you’re enjoying yourself. But then you remember – every two seconds, you remember – that no one in Gaza can eat like that.”
[See also: Former head of Shin Bet: Hamas’s nightmare is a two-state solution]
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