On Life and Death in Gaza
A doctor shares his story.
by Abdelkareem Alsalqawi
My name is Abdelkareem Alsalqawi. I’m 32 years old. I was born in Gaza, in Deir al-Balah city. Deir al-Balah is a small city by the beach in the middle of the Gaza Strip, famous for its palm trees. I’m not married. I live with my parents, my sister, and two of my married brothers in the same house in Deir al-Balah.
As a doctor, I was working until recently in Al-Aqsa Martyrs Hospital in Deir al-Balah, where I had been doing 24-hour shifts every two days since the beginning of this war on October 7, 2023. But four or five months ago I started working at Nasser Medical Complex in the city of Khan Younis, to continue my orthopedic residency. At Nasser, I also work a 24-hour shift every two days.
Because I live in Deir al-Balah, to get to work I have to go from my house to Khan Younis. The distance is about 10 to 15 kilometers. On a normal day, I would take a car to get there. But due to the crisis of fuel here in Gaza, there is no gas. The alternative is to take a donkey cart, to walk the long distance, or if you have a bicycle, to cycle there. Thankfully, in the last couple of months the Ministry of Health has started to provide buses to carry doctors, nurses, and the medical staff from their areas to the Nasser Medical Complex.
So this is how my days start: I wake up at 6am, gather my items, and prepare my bag. I put some food in the bag, because there is no food in Nasser itself and there is no food around the hospital. (If I’m lucky enough to find some food in Khan Younis, the prices are insane so I can’t afford it.) Then I head to the bus pick-up point.
The road between Khan Younis and Deir al-Balah is not that safe. We pass through red zones, for which the IDF have issued evacuation orders. They’re supposed to be evacuated, so many artillery shootings and many explosives are expected. Normally, a bus ride along the coastal road would take 15 minutes. But because Rafah city to the south and the eastern part of Khan Younis are now occupied, there are hundreds of thousands of people—maybe 500,000 people—living along the road in a small area, the al-Mawasi zone, by the sea. With the overcrowding and diverted routes, the whole journey takes closer to an hour. There is no space in the bus, so I stay standing. As we drive to Nasser, we pass the tents of the displaced.
We reach the hospital at eight. The day starts with a morning debrief among the doctors about the previous night, and then we start spreading ourselves to the different units—to the ER, the operating theater, the wards, or the clinics. At eight, we start seeing normal people, people who come to the ER for a consultation, for a daily dressing or something like that.
At nine, we start receiving casualties. That’s when GHF, the Gaza Humanitarian Foundation, open their doors. Thousands of starving people are waiting for these aid distribution centers to open. Soon after, we start receiving 50 or 60 injuries per hour.
These injuries are mostly gunshots. As an orthopedic doctor, I take care of gunshots or injuries to the upper limbs, lower limbs, and back. Most of the injuries that come in from GHF sites are orthopedic: they shoot mainly at the limbs, so some 70% are orthopedic cases. (Another 20% are penetrating gunshots to the abdomen or chest, and the remaining 10% to the genitalia and the head.) In the ER, we have three doctors of orthopedic medicine. We three are supposed to take care of 50 patients at once. There is no luxury to take your time to evaluate the patient. You have to be quick.
There are no beds in the ER. The beds are in the wards upstairs for patients who are admitted, and even those patients are sleeping in the corridors, behind the elevators or next to the bathrooms. In the ER, we treat patients on the ground. I treat patients on my knees, taking decisions in less than a minute and moving from one patient to another on the floor. The ER is overcrowded—it becomes like a shuk, a marketplace, in this small space. Every five minutes you have an argument with someone, because you need space to save your patients, you have to give the proper care in the shortest time, and then you have to move on. This is the first struggle.
The second struggle is the lack of resources in the ER: bandages, gauze, fluids, antibiotics, analgesics and opioids for pain relief. We simply don’t have enough, because every day for the past few months—since the GHF centers opened—we have to deal with a mass casualty event. The borders are closed, and nothing comes in except for a few supplies from international organizations. It’s not enough. Every day I improvise. I use the curtains or the sheets in the ward: I cut them, put some iodine on them, and rub the wounds, at least to put some pressure to stop the bleeding until I go to radiology, take the x-rays, do blood samples, then take the final decision on that patient.
More than once I have chopped a leg or a forearm or a hand without anesthesia. I remember one case very well: it was at Al-Aqsa Hospital, about a year ago. It was a little child—a male patient, two years old—and I took his left leg out below the knee. We had to move quickly to stop the bleeding. I don’t exaggerate when I say there simply was no analgesic at the ER back then. Now the situation is a little bit better, but still we struggle. To save resources, we give diclofenac or paracetamol for pain relief. For a patient with an open fracture, with a leg about to be amputated, how can a paracetamol ease the pain? But what else can we do?
This is the situation for the past month or month and a half. We continue to receive massive casualties until at least after midnight or one in the morning. Imagine: you start your shift at nine and you are at the ER until after midnight. You are coming from a home with no proper food. At the hospital there is no food served for the staff. There is no coffee, no sugar, no chocolate bars or protein bars. So what I have is the food that I brought from my home, usually one loaf of bread, a few olives, and a tomato. This is my food for the day.
If you go outside the hospital looking for some food, you would be shocked by the prices. One kilogram of tomatoes used to cost, in normal days, one dollar. Now it costs $3.30. So you can’t just go to work and buy some food. The other side of the story is that you don’t receive a salary from the government here in Gaza. The government has collapsed. What’s left in Gaza of a government are the hospitals, mainly, and the medical staff. Lately, the so-called government here in Gaza has provided us with $200 every two months. Obviously this is not enough, but we don’t have other options. We start seeking any kind of work. A colleague of mine fixes shoes. Others try to mend clothes or carry goods—anything to bring extra income home.
For me, when I have a break or I have an hour of calm in Nasser without any patients coming, I go outside to the street looking for something cheap to take back to my family. That’s what I keep thinking about in the hospital: I keep thinking about going out and buying some stuff because I know the prices are insane. So the whole day you keep thinking about your house. You keep thinking about water. You keep thinking about charging the batteries. You keep thinking about whether your area is safe or not. You keep thinking about the food in the house. You keep thinking about your family while you are dealing with patients in the ER.
If you are lucky enough to have some rest overnight, in the morning you change your clothes and you wait for the bus to get you out of the hospital. Before leaving, I see my colleagues—and sometimes I do it, too—collecting any cartons, plastic, or empty bottles from the hospital, putting them in a bag and bringing these items to their homes. Why? Because there is no cooking gas. Now we depend on fire to cook our food and boil our water. To set a fire, you need some kind of fuel. There is not enough wood in Gaza for everyone to set fires daily, so we carry these empty containers and use them to set a fire.
Staff who are not lucky enough to have water in their areas carry water from the hospital to their homes. So in the bus you see a doctor who carries water and a bag full of plastic bags or cartons. He’s a skilled surgeon. Last night you saw him in the operating theater handling patients. But in the morning you see him carrying these bags, carrying gallons of water, exhausted and drained.
You see such scenes and you keep thinking “how did we reach this position? How can a surgeon tolerate being in such a position?” I don’t know how we can function well—how we are still functioning well—in such circumstances. I don’t know how our mental health is still stable, how we can still take decisions and deal with patients in normal ways.
And yet, surprisingly, thank God we are functioning well. Speaking for myself: I’ve never missed a fracture. I’ve never missed a bad injury. I’ve never missed a bleeding vein or artery. We try to stay alert. We try to stay cautious. We try to stay focused on our patients, take our time to examine them and evaluate them. The mistakes that are made in the ER are small, and they can be forgiven in such circumstances. So we are still functioning very well. This is not only my testimony. The international doctors who sometimes come to help say the same.1
In addition to my shifts at Nasser, I also work in a field hospital in Zawaida in the middle of Gaza, which is run by Doctors Without Borders. I work there on a day shift, coming off the insane shift at Nasser. Here patients come from other hospitals—from Nasser, from Al-Aqsa, from Al-Shifa—any governmental hospital still working.
For the past week or 10 days, we have also been receiving casualties from aid airdrops. These airdrops land in specified areas, but there isn’t that much food in them. With thousands of insanely hungry people, you can imagine the clashes over these packages. When a package lands, people run immediately to collect what they can. So we keep receiving massive mass casualties from the conflict over these packages.
Last week, when I was in the field hospital, I received maybe 20 patients at once after an airdrop nearby in Zawaida. Most of the injuries were due to gunshots or deep cuts with knives. I don’t judge anyone: they are starving people who see food coming from the sky. They see it as an opportunity to help their families.
One case hit me hard. At 10am I was at the field hospital and a former colleague of mine from Al-Aqsa Hospital, a nurse, came to the hospital with his aunt. She was not doing well. We did some lab work and we helped her. The nurse, Oday, thanked me and told me how happy he was to see me. It was weird, because we’re not that close, but he hugged me. Then he left the hospital with his aunt.
At 12pm, two hours later, Oday was brought to the hospital, dead. He had started chasing one of the airdropped aid packages, and apparently the package landed directly on top of him. His skull was smashed; his face was smashed. We couldn't recognize him immediately. We recognized him by his clothes, because two hours earlier I had seen him with the same clothes. He was brought to the hospital dead because a package of food from an airplane that was supposed to help him killed him.
Until recently, my home of Deir al-Balah was one of the cities that the IDF did not invade completely, so it was one of the cities that still had its infrastructure, buildings and streets. Two weeks ago it was evacuated.
When the IDF issued evacuation orders for our area, we left our house in a rush. We went to live at my aunt’s in an unfinished apartment. We took what we could take: some food and some light materials. We couldn’t take heavy luggage because we don’t have cars. Instead, we took a donkey-drawn cart for which we paid 500 shekels—around $160. We were among the lucky ones, because we had a place to go. Most people did not, so they slept on the street. As we headed north, I could see people I knew sitting in the streets. They slept on the street that night.
We stayed at my aunt’s apartment for at least a week, anticipating the news about our neighborhood and whether our home was damaged or not. We could hear the explosions and see the smoke rising from our area. After a week, we went back. Thank God, we found our home still standing.
It is damaged, but it is standing. My uncle’s house was damaged. The family house was completely destroyed. The mosque, the community center, the school in the area, the kindergarten, the main street—my whole neighborhood is almost completely demolished. But my house is still standing, which is a big blessing. If you don’t have a house right now in Gaza, you have to live in a tent. Living in a tent in the heat and humidity is a struggle.
One kilogram of sugar, which used to cost less than a dollar in Gaza, now costs around $100. One can of ordinary tuna used to cost two shekels, which is half a dollar. Now it costs 50 shekels. The list goes on and on. There are no chocolate bars. There’s no meat. The last chicken I ate was six months ago with my family.
So you are in a struggle right now: you have to buy aid stolen by the armed thugs and gangs, otherwise you would be starving. You can ask: why don’t you go to one of the distribution centers set up by GHF? If you go there, it’s 50-50. There’s a chance you go there and bring something back, and a chance you return with a gunshot to your limbs or your head. So I told my brothers, “I’m not sacrificing you. Do not go there. We can eat anything. We are not going to be starved; we can eat even a piece of bread or a little bit of tuna. But do not go to these centers.”
An alternative is to go to the aid trucks when they are raided. For me, this isn’t an option. I have a moral compass. It is not legal. It’s not humanitarian. I refuse to lose my dignity and my honor by stealing from these trucks. And even if I did, there is a high chance I would be injured. Your life in Gaza at the moment equals a bag of sugar, of flour, or of macaroni. Doctor, nurse, lawyer—it doesn’t matter now. A thug or any starving person in Gaza can kill you, or at least injure you, because he wants the sugar or the flour or the food in your hands. It is like a jungle.
These thugs now number hundreds because there’s no government in Gaza. If you have weapons, you can take whatever you want from people. These organized thugs are protected by the IDF, by which I mean that when they steal the aid off the trucks, sometimes what is left of the government’s security forces [editor’s note: these security forces are Hamas police or internal security] try to stop them—but whenever the security forces come close to the thugs at the aid trucks, the IDF drones launch airstrikes on them.
As a result, something like eight percent of Gazans have millions in their pockets—literally, millions of dollars. These are the thugs and the thieves. The rest of the people are poor and do not have anything to eat, except what they are lucky enough to buy from the gangs. We are at the mercy of the IDF, of the thieves and the thugs, and of the local government here in Gaza (which is not helpful at all). Then there is the famine, the heat, the humidity. Under these circumstances, you are expected as a doctor to keep functioning well. You keep going to the hospital. You keep treating patients.
For me, I go to the hospital not for a salary. Two hundred dollars every two months is not worth it. I go there because I know that if I don’t go there, no one will fill my place. Many of our colleagues were either arrested or killed or left the country because their families kept pressing them to leave. We lost hundreds of skillful doctors. Now we have a shortage, and no one will help these injured people. So I keep reminding myself I’m doing what I am because I am a doctor and I have to do it. I can’t just stay home doing nothing.
Once, I tried staying home. Nasser Medical Complex was at risk and under fire. My mom begged me not to go and my friend begged me not to go. So I didn’t go. It was only one day, but still I kept blaming myself. For the next few days I went back, and I’ve kept going since. I think most of my colleagues do it for the same reason; it’s not that we’re obligated to go. But we know that if we stay home, no one will fill our place.
The oath I took when I was a medical student was to keep helping those in need. This is the only positive aspect of my job: I feel I’m doing something for my people. If I had a note and I was writing how many lives I have saved, it would be full. Thank God, I’m lucky to have this job. I have saved hundreds, if not thousands, since the beginning of the war. I’m fortunate to have this opportunity. I don’t regret it.
Abdelkareem Alsalqawi MD is an orthopedic resident in Gaza. He earned his medical degree from the Islamic University of Gaza. In 2017 he was a member of the YaLa Young Leaders cohort, a forum that brings Israelis, Palestinians, and young adults from across the Arab world into conversation about the region and its challenges.
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At some point we started receiving international doctors. But when it is only one to two doctors to a team, and they are not used to having this immense number of patients, they are not that helpful. We don’t lack general practitioners or orthopedics or ER doctors. We lack the specific specialists, such as peripheral nerve surgeons and vascular surgeons. This is what we need. We keep calling for such specialists to come, but every time we still receive orthopedics, general practitioners, and ER doctors. Some of them are not even dealing with patients; they do administrative work. So now even if we see a medical mission coming, we are not optimistic. If you want to make a difference as a medical mission, come to Gaza and bring unique specialties and bring medical supplies. We need medical supplies. And as doctors, we need financial help to stay focused on our jobs in the hospitals and not have to think about our families back home.
Respect for running this.
While I supect Abdelkareem and I won't agree about some things (Haviv Rettig Gur is probably the person who has most shaped my perspective about Gaza), I have incredible respect for everything he is doing. Truly heroic.
I hope that the fighting will end soon, that the remaining hostages will be freed, and Hamas will surrender or flee so that Gazans can have a chance at a decent life.