DAY IN LIFE OF SHIFA HOSPITAL:Medics in Gaza are working under terrible stress and conditions, write Rory McCarthyin Jerusalem and Hazem Baloushain Gaza City
KAREM BATNIJI, a young surgeon at the Shifa Hospital, Gaza's main medical facility, worked straight through the first 48 hours of Israel's war in Gaza. These have been gruelling days for Gaza's doctors: long hours, immense pressure and thousands of horrifically wounded patients to treat - many of them civilians. In the initial days of the Israeli offensive, hundreds of patients would arrive at once.
"I was dealing with some people in the corridor, even making operations in the corridors," he said.
"On the first day we were just looking for the good cases, the people most likely to make it. With the badly injured we'd spend a long time, exhaust ourselves and take up a lot of staff, so we just had to find the good cases and focus on them. When they brought the bodies in, I found myself standing there saying: this one to the morgue, this one to the intensive care unit, this one the morgue . . . It was very hard."
Among the dead have been medics: at least 11 medical staff had been killed and another 17 injured as of Wednesday last week, according to officials.
After two days on duty, Batniji went home. "I couldn't sleep. I was just remembering: the cases, the blood, the operations, the corridors. I thought a lot about the difference between life and death. It's often just a few seconds." Batniji (29) trained to be a doctor in Egypt. But nothing prepared him for what he sees every hour in the operating room.
After operating on a 50-year-old woman with a serious stomach injury one day last week, he slipped out for a quiet cigarette. Before he could finish it he was called back in for emergency surgery on Osama Lobbed (18) who his family insisted was a civilian. A first-year university student, he was hit by shrapnel from an Israeli shell as he stood outside his Beit Lahiya home. He was clinging to life: both his legs almost completely severed, his stomach full of shrapnel, his liver sliced in two.
The boy's family stood outside in the corridor to wait. Three hours later, the patient was sent down by lift to the intensive care unit, with a nurse operating a manual ventilator, and the family crowded round Batniji as he stepped out of the theatre. "What's going on? How's Osama?" they all shouted at once. "He's in a very bad situation," the surgeon told them. What he could not bring himself to say was that although he had avoided amputating Lobbed's legs, the boy would almost certainly die.
Batniji and some colleagues later discussed the contorted politics of Gaza. "Sometimes I disagree with these Hamas people, but we are human beings, we are one people. I'm a doctor and dealing with patients as a doctor," he said. "Nothing more."
Even some of the world's most experienced war surgeons have found the situation at the Shifa particularly difficult.
"It's quite gruesome. The hospital is the place where you have the ultimate confrontation with the facts of this kind of armed conflict," said Harald Veen, a Dutch surgeon who is part of a four-person team from the International Committee of the Red Cross who have spent the past week helping at the Shifa.
Because the hospital is in the centre of a city under heavy bombardment, patients who might otherwise have died are often brought in and operated on within 20 minutes of being hurt and sometimes survive, though with terrible scars and disabilities.
He said the doctors, whom he knows well from several years of visits to the Shifa, were well trained and that any large western hospital would be overwhelmed by the number of casualties they had seen. He was struck by the commitment of the doctors but said even for Gaza this was an unprecedented burden. "It's never been like this. That's obvious for everybody," he said. Veen has worked in conflicts for the past 16 years, most recently in Iraq and Chad.
But he is still struck by the appalling injuries. "One day started with a girl, six-years-old, with one arm blown away and a tear in her lung, and that's just the first operation," he said.
"If they survive it's a lifelong disability. The day before, a man with both legs blown away. I fear in the western media we are too clean. "War wounds are horrible, especially blast injuries due to high explosives.
"Simply put, bombing causes horrible injuries. This is the routine of daily life in the Shifa."