The air strike caused a plume of dust to fall from the roof of the lift. Its interior shook, just for a moment. The medics sighed. It was close, they noted.
Outside Nabih Berri Governmental Hospital, which is situated on a hill overlooking the Lebanese city of Nabatieh, civil defence volunteers were putting down their cigarettes and coffee cups and readying to embark on another rescue mission – even with the knowledge that Israel might hit the same place again. The medics inside the building readied themselves, too. Soon, three injured people would arrive in an ambulance; one, with serious eye injuries, was transferred straight to another hospital because there was no ophthalmologist at Nabih Berri.
From a balcony, a group of nurses watched plumes of smoke rise, one on the left and one on the right. Over the past month, their city has become a map of destruction. The landscape of toppled buildings brought to mind medical cases – people they had saved, and those who weren’t so lucky. One pointed out a destroyed building: it took rescuers four days to find two dead women there, he said.
In what it says is a fight against Iran-backed militant group and political party Hizbullah, Israel has launched one of the most intense aerial campaigns in contemporary history, bombarding Lebanon from the skies as well as launching a ground invasion. More than one-fifth of the country’s population of roughly 5.2 million people has been displaced, while one-quarter has received evacuation warnings.
Nabatieh – located north of the Litani river and the UN-declared buffer zone – has been under Israeli evacuation orders since early October. Despite this, civilians remain, and it is for them that the hospital stays open, staff say.
As well as being a city, Nabatieh is a district, with a population of roughly 155,000 people, and a wider governorate, home to just under 400,000 before the current war. A local official estimated that between 500-600 civilians remain in the city itself, with more in the surrounding villages.
“The hospital is still working, treating every person – men, women, children,” said Dr Mukhtar Mroue, standing by the entrance. “We are here to help civilian people, we can’t leave this area.”
Like the roughly 74 other remaining members of staff, he sleeps inside the hospital. Many of their family members have moved in too. When The Irish Times visited, there were 14 in-patients in a facility that used to care for up to 167. New cases arrive constantly, before being transferred on to other hospitals. Staff believe it is better to have people relocated to a calmer, safer environment as soon as possible.
Despite being certain of their importance, “it’s not easy to stay ... We are worried,” said Salma Kamso, the head of the procurement department. She said she hasn’t been home in three weeks. They are running low on fuel, which they need to power generators, and have medicine to last a fortnight. Getting supplies is complicated when the roads in and out are so dangerous.
A man missing both of his legs wheeled himself past as she spoke.
“It’s our duty of course. So many wounded people,” said Dr Mroue about remaining there. But, she added, “We have to take care. We don’t trust Israel.” Israeli forces have been known to target hospitals and medical centres, in both Gaza and Lebanon. In the month from mid-September, the World Health Organisation (WHO) said there had been at least 23 Israeli attacks on health facilities and health transport in Lebanon, leading to 72 deaths and 43 injuries of health workers and patients.
At least 100 primary healthcare centres and dispensaries in conflict-affected areas have been closed due to increasing conflict, intense bombardment and insecurity, the WHO said. Israeli forces say ambulances have been used to transport weapons and fighters, without providing evidence. This week, it accused Sahel Hospital, in Beirut’s southern suburbs, of hiding a bunker containing cash for Hizbullah – claims the hospital strongly denies. Another air strike on Tuesday, not preceded by any evacuation warning, caused damage to the entrance of Rafik Hariri University Hospital, Lebanon’s biggest public health facility.
Beside Dr Mroue was Dr Hussein Soueiban, who cited the Hippocratic oath to explain the doctors’ decision to remain in Nabatieh. Then, sirens began sounding. “We have to go, we have some injuries,” he said, and they walked quickly away.
In his office on another floor, hospital director Dr Hassan Wazni sat at his desk, Lebanese channel MTV playing news on the screen across from him. Dr Wazni was smoking a cigarillo – a gift from Beirut, he said. He slept two hours the night before and looked exhausted. “It’s hard, it’s very hard,” he said. “We don’t have the time really to sleep as usual ... it’s not only me. All of us are like this, waiting, waiting for something to happen. We heard all the night bombardment and these things.”
He said the hospital used to be one of the most important oncology centres in southern Lebanon, but now they just treat emergencies. They’ve gone from having 150 doctors before the escalation to about 18 now. They require 1,200 litres of fuel every day to keep going, relying on generators because Israeli air strikes cut off the broader electricity supply. The government is giving them no support, Dr Wazni said.
[ In pictures: In the rubble of LebanonOpens in new window ]
He estimates that only 3 or 4 per cent of residents from the surrounding areas remain. “They can’t rent ... they don’t want to stay in schools [that have been turned into displacement shelters].” He said some who left were killed in other places, lending to the common feeling that nowhere is safe.
Dr Wazni took prayer beads into his hands as he spoke. “We are dealing with this crisis, waiting for the end, [hoping] that it won’t be that far, that it won’t be long but ...” he trailed off. When asked whether he’s worried about a further escalation, he responded: “What escalation? They destroyed everything.”
As he was speaking, another boom sounded in the background. Dr Wazni looked out his window to check where the smoke was rising from.
Ali Omeis, a nurse supervisor, brought The Irish Times on a tour around the hospital. Every employee now sleeps in their own department, he said. The hospital kitchen prepares food for them all, with some employees’ family members assisting the kitchen’s usual staff.
In one room was a 52-year-old man, shaking and grimacing in pain as the dressings on his left arm were changed. About 25 per cent of his body was covered in second- and third-degree burns, medics said. He was attached to an intravenous drip.
The man, who did not want to be named for security reasons, said he was a member of the civil defence and was responding to an air strike when another landed, minutes later. His friend was killed, while a second person – more than 80 per cent of his body burnt – was transferred to another hospital. So-called “double tap” strikes are generally considered illegal under international law, because they usually target civilians, including first responders. The Israel Defense Forces (IDF) did not respond to a request for comment about this.
In another bed was a semiconscious 80-year-old man, his breathing laboured, who had been admitted with a hip fracture before the escalation. The man’s home has since been damaged by an Israeli air strike. “It’s really hard,” his daughter said. She stays in the hospital too. “There’s no place to go.”
Another man – cuts on his face, a drip attached to him – was one of seven people injured in the same family, after he said an air strike targeted their home. Their father is in a critical condition, he said. Two neighbours – a woman and small child – were also wounded. “We stayed in our houses because there’s no place to go,” explained the man – an electrician by profession. He asked that his photograph not be taken, so as not to worry his relatives.
Alongside the injured, the hospital receives a lot of dead bodies, Omeis said. “Most dead patients, they can’t be recognised by their faces because of the scale of the aggressive injuries.” With no DNA testing available, they need to send body parts to other hospitals. “We have a mouth, a leg. Other hospitals say they have a dead person missing these parts and we communicate with them, it’s like a puzzle.”
In other cases, they can identify the dead person but it is impossible to transport them to their family. “We have four [bodies] here now whose family know [they’re here] but they can’t come back. The families are afraid.”
Omeis said they will keep the remains for up to six months, to allow the funerals to take place when it is possible.
The civilians remaining in Nabatieh and its outskirts are generally poor, medics repeatedly explained. They have limited contacts elsewhere and are unwilling to leave behind everything they’ve known to live in schools-turned-shelters or on the streets. Many say moving is pointless anyway, because areas across Lebanon are being targeted.
Efforts to help them have ended in tragedy. On October 16th, air strikes targeted Nabatieh’s municipality building, killing major Ahmad Kahil and 15 others as a meeting was taking place regarding how to distribute aid. Mohamad Shpib was one of the survivors – he had gone out for coffee. Back on the site, reduced mostly to a mass of grey rubble, he pulled out bags of bread; boxes of medicines; and pointed at pasta, tuna cans, and bulgar wheat. Some cardboard boxes of aid were branded with Unicef and Mercy Corps logos.
Dr Wazni said the government hospital received 36 injuries from that bombing, most of them people who went to the municipality building to ask for help. It “was really a catastrophe. It was something huge,” he said.
Israel also destroyed Nabatieh’s Ottoman-era market this month. Evidence of a US-made munition was found on the site, prompting increased anger towards the US for supplying Israel with weapons. “The old man Biden, he’s sick, he doesn’t know democracy,” railed Shpib, the surviving municipality worker. “We were happy with America before, now we hate them. We will not leave our land, we will get victory or die. We will stay on our land even if we eat rockets here.”
In an area that Israeli assaults have reduced to a wasteland, the public hospital now acts as a centre of life. Roads in and around Nabatieh were eerie, empty. There were countless shuttered businesses; building sites abandoned. A supermarket, gutted by an air strike, still had coated-grey produce visible on its toppled shelves. Clothing stores, their rails hanging and mannequins askew, had gone unlooted. A bank’s alarm was going off inside its broken facade, with no one around to hear it.
Stray dogs and cats picked their way through shards of glass and torn documents scattered across the ground. These were the remains of lives, of whole communities; the consequences of a brutal devastation that seems far from finished.
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