Front Burner - Life and death at a Gaza hospital

Episode Date: January 9, 2024

A few weeks ago, Syrian-Canadian doctor Anas Al-Kassem, along with 5 other doctors from the U.S and Canada, went on a medical mission to southern Gaza. They were stationed at two hospitals in Khan Younis. With explosions nearby, they closed wounds, amputated limbs, and saved the lives that they could. Today, Dr. Anas Al-Kassem on what he saw during the mission, the state of the hospitals in Gaza, and the continuing health and humanitarian crisis in the region. For transcripts of Front Burner, please visit: https://www.cbc.ca/radio/frontburner/transcripts Transcripts of each episode will be made available by the next workday.

In the Dragon's Den, a simple pitch can lead to a life-changing connection. Watch new episodes of Dragon's Den free on CBC Gem. Brought to you in part by National Angel Capital Organization, empowering Canada's entrepreneurs through angel investment and industry connections. This is a CBC Podcast. Hi, I'm Damon Fairless. On Christmas Eve, just a couple weeks ago, Dr. Anas Al-Khasim, who often works as an ER surgeon at a hospital in southwestern Ontario, was in a very different kind of hospital. It's one he spent days traveling to, from Canada to Egypt, 14 hours across the Sinai Desert, and finally through the gates of the Rafah Crossing into Gaza.

Dr. Al-Kassem is experienced working in war zones. He traveled to Syria several times during the civil war there, but he wasn't quite prepared for what he found in Gaza. You will see immediately thousands of refugees, thousands of families in the vicinity of the hospital. A lot of tents, people are trying to cook from a basic, you know, they have some wood because there is no oil, no gas, as you know. They're striving and trying to find some water. You see children everywhere in the vicinity of the hospital. You see wounded and injured patients on the ground, on the floor, in the entrance, on the stairs. I've never seen this even in my medical missions to Syria, never.

According to the World Health Organization, Gaza has 13 partially functioning hospitals, two minimally functioning ones, and 21 that are no longer functioning at all, all serving a population of over 2 million people, roughly 85% of whom are now displaced. The death toll reported by the Gaza Health Ministry has surpassed 23,000. The injured are well over twice that, and the majority of them are women and children. The Israeli army's airstrikes, in response to the Hamas attacks of October 7th, were largely focused on the north at first. More recently, though, they've been focused on the south, in places like Rafah and Khan Yunus.

That's where Dr. Al-Kassim, along with five other doctors from the U.S. and Canada, were stationed for almost two weeks. They were part of a mission coordinated by the World Health Organization and Arama Worldwide, a humanitarian relief organization. With explosions nearby, they closed wounds, amputated limbs, and they saved the lives they could. I had to do some stitching on the floor in the ER, in the European hospital, without painkillers.

Because, you know, when you have, you know, one or two patients in a Canadian hospital, even if it's a gunshot, you still have a lot of, you know, resources and nurses around you to take care of two patients. But when you have and receive influx of 15 injuries at once, which was the case in both hospitals, actually, almost on a daily basis when there is an airstrike nearby. I mean, then you find yourself helpless at some point, because I have two nurses working with me, a couple of physicians, and 15 severe injuries. And sometimes difficult to appreciate where you're going to start with.

Today, Dr. Anas Al-Khassem his time in southern Gaza and the state of the hospitals there and the continuing health and humanitarian crisis. Starting with more about what it was like on the ground in the hospitals. So I had to do some stitches quickly and without any anesthesia or painkillers.

We had to save what we have for the OR, for the intensive care unit, but we cannot use everything on the floor and in the ER department because we know that there is a significant lack of these analgesia, painkillers, and even antibiotics. So it is different than how you practice medicine in Canada, U.S., and the Western world, unfortunately. You have to be innovative and try to save whatever you think. It's less complex because if you spend more time with the complex injuries, you're going to lose the moderate injuries.

That's, unfortunately, the reality. I'm getting the sense, and it's not surprising to hear that your time there was intense. I'm just wondering if maybe you can help build out that picture a little more. What was a typical day like for you and your colleagues there? So a typical day would be that when we wake up in the morning, most of the bombardment happens unfortunately at night. And I expected to receive a lot of injuries in the middle of the night. But in the morning, the ambulances, people, they told me that it's not safe. Any ambulance would be moving. It's a target by the Israeli forces. So they cannot go and evacuate the injured. And unfortunately, that's

why the death rate is pretty high in Gaza war. Within three months, we have more than 20,000 deaths. That's a huge, if you take into consideration the three months of this war. And the reason they said it's really unsafe to move and evacuate patients from beneath the rubble at night. So we would wait on a daily basis until the sun rises. And by 7 o'clock, you would see always tons of injuries coming, 15 to 20 injuries filling the ER, some of them already dead. Some children have pulse, but you look at them, a quick assessment, you know, head injury, chest, abdomen.

You think you're going to spend a lot of time. You move to the second child, you feel this is likely salvageable. So you focus your team and direct the nurses with me, the very limited healthcare staff with me. Let's just focus on that child as opposed to the first one. Unfortunately, you have literally, Damon, to make the decision who's going to live and who's going to die. In ideal situation, you probably, you could have saved both children, but because of the, you know, lack of resources, the human resources, medical supplies, you have to focus on what's likely is salvageable. And then you leave the other child to die before your eyes. It's quite hard. Well, I mean, you say it's quite hard, but I mean, it sounds

incredibly traumatic to be in that position. How often are you making those kind of decisions? On a daily basis. On a daily basis. Whenever there's an airstrike, it is not only two or three patients who will receive 15 or 20 injuries. Because when a house being bombarded, all these refugees are seeking refuge in the houses in Rafah area or in the tents, and it's so overcrowded. So even if it's beside a house, you'll have a lot of casualties coming to the hospital at once. And this is happening every few hours. So we get a little bit of rest if we get any rest. But then again, they call us down and there is 15 or 20 injuries among them. Probably 50% of them are children. And then we have to make a decision who's going to go to the OR. And one injury doesn't mean one surgeon will work on that. Like I had a neurosurgeon with me and thoracic surgeon from Canada and

myself as an abdomen and trauma surgeon. sometimes we had to work on the same child and the same body, the three of us. And that would take a lot of times and efforts to be able to save one life by three surgeons at a time. I want to ask a little bit about some of the injuries you were seeing. One of the things that we've been hearing is reports from Human Rights Watch that the IDF has been using white phosphorus bombs in areas populated with civilians, and that's against Geneva Conventions.

Amnesty International says it's verified videos showing white phosphorus artillery shells being fired by the Israeli army into civilian areas in Gaza. White phosphorus is used as a smoke screen or as a weapon. It ignites when exposed to air, and it can burn through flesh, causing horrific deformities. air and it can burn through flesh, causing horrific deformities. I guess I'm curious whether you saw any evidence of burns that might be attributable to that kind of incendiary device. Yeah, I cannot confirm it was white phosphorus, but where I work in Canyons, Damon, I've seen a lot of third degree burns, particularly in the extremities. And I'm not sure what kind of bombs have been used on civilians in

these areas. And when you look at the extremities, you think immediately it is not going to be salvageable. And therefore, the orthopedic team immediately would make a decision for amputations. We have done tens of amputations on a daily basis from the morning until midnight. And unfortunately, in ideal situations, if you don't face these kind of severe injuries and third-degree burns, probably you can do some reconstruction and put the limbs back together or do some vascular surgery. But unfortunately, in this war, which I never witnessed before, we had to do an amputation almost on every second case. It sounds like your days and presumably some of your nights were spent, you know, in the hospital doing the work you're talking about.

But did you get a chance to go outside the hospitals? Did you see anything? I'm just curious of getting a broader picture of what things are like on the ground there. Yeah, I mean, we had a few hours during the trip where it wasn't so busy in the hospital. So I went outside and I wonder a little bit, just, you know, a few hundred meters from the hospital, we've been told don't go far away because it's unsafe. And you see the misery, right? You see the children, you know, trying to find water. Sometimes I've seen children trying to grab a small cup and get some water from a dip on the street, if they can find some water probably,

and get it back to the tent and boil it and use it. It is horrific what we have witnessed. There are some people trying to sell stuff. No stores, of course, no groceries, nothing, the whole infrastructure gone in Gaza. But you see some people trying to sell, you know, canned food, tuna or, you know, and things like that, beans. But it's very expensive. And the families of the patients that I treated, they tell me they don't have even enough money because they had to leave their houses all of a sudden from Gaza, northern Gaza, and they did not even take any penny with them. So even if you find some food, it's canned food, it's not proper food to live on for a long period of time, but still many patients, they cannot, or our families, I should say, they can't afford it. I'm going to go. capital organization empowering Canada's entrepreneurs through angel investment and industry connections. Hi, it's Ramit Sethi here. You may have seen my money show on Netflix.

I've been talking about money for 20 years. I've talked to millions of people and I have some startling numbers to share with you. Did you know that of the people I speak to, 50% of them do not know their own household income? That's not a typo. 50%. That's because money is confusing. In my new book and podcast, Money for Couples, I help you and your partner create a financial vision together. To listen to this podcast, just search for Money for Couples. You know, we've been talking about trauma surgery, the kind of work that you've been doing. But one of the things that is, you know, the WHO has been talking about, and I think, you know, anyone who's experienced this kind of devastation worries about is that the secondary kind of health issue, which is communicable disease. I'm curious what kind of things you were seeing there.

Yeah. I mean, we spent most of the time as trauma surgeons in the OR or in the ER, but we had the opportunity to check on the tents, and you see all kind of infectious diseases. Patients have fever, coughing. Some of them have diarrhea. And malnutrition, Damien, is quite obvious. I've been told by the nurses and doctors there that most of the patients are anemic.

This is one sign of malnutrition because of 30 days of hunger and no proper food. There's a huge blockage, as you said, to food and water and proper nutrition. A quarter of Gaza's population is already starving, more here than in the rest of the world combined, says the World Food Program. With Israel screening and limiting aid at the borders, and with it impossible to widely distribute amid the fighting, everything is in short supply.

This is quite obvious when you meet the family of the patients, even not only the patients, that they are malnourished. They're skinny, they look pale, and many of them are coughing. But unfortunately, with the limited resources, you have to focus on damage control, you have to focus on the bleeding. So there's really no resources to take care of the chronic diseases and illnesses in the tents. just healthcare center in the territory, Israel, along with U.S. intelligence, said that the hospital was being used as a Hamas command center. And then later, a detailed analysis by the Washington Post came out determining that there wasn't really strong evidence of that. So I guess I'm curious about your experience in the hospitals you were in. Were there any signs of Hamas leadership or fighters? Not at all. Not in the two hospitals in Can Yunis,

the Nasser Hospital and European Hospital. I never seen even fighters, to be honest with you. Never seen fighters as injured coming to me. They were all civilians from the nearby area. Many of them are children. But I had the opportunity, Damon, to talk to great physicians who were pushed from Al-Shifa Hospital,

which, as you said, was the largest hospital in Gaza, with dialysis units, with neonates capacity, ventilators and so forth. Hundreds of people who had been sheltering at Gaza's largest hospital evacuated on foot. Infants and newborn babies are left without oxygen. It is nothing but a medieval cave. It is no longer a hospital. The occupation forces draw the medical teams out of the hospitals. On the road, I can see very appalling scenes. They told me horrific stories, how they were interrogated, how some of them were detained. The head of the al-Shifa hospital is still detained there. But then they said, you know, the IDF came in, and for several days they, you know,

kept them under siege with no water, no food. And many patients died because of lack of food and lack of electricity because they needed ventilators, including a few neonates out of, I guess, about 40 neonates who were in the hospital at the time. They always claimed, we are here to find Hamas people, you know, fighters. And the physician, the plastic surgeon, Dr. Ahmed, he told me that they spent hours and hours interrogation with him. And they did not find really any command center or any Hamas. And he told them, you know, we're physicians here, and do you think that if there's any

Hamas fighter, we'll be staying for you until you, you know, invade the hospital? I mean, it was really sad how our colleagues, the physicians, nurses under attacks have been treated by the IDF during that period of time. And then he told me the bulldozers really crushed the cars outside because they want the people, patients and medics, to walk on their feet to leave down to South Gaza. It was quite horrific moments that I've heard from some physicians. They escaped in the north down to South Gaza. Now, this isn't the first time you've provided medical care in a war zone. I know that you were doing, I think, quarterly tours,

voluntary tours to Syria during the Syrian civil war. Can you tell me a bit about what you saw on those tours? I mean, the Syrian war was horrible. It wasn't better in terms of the casualties and the civilians and children that were hit because of airstrikes by the Syrian regime. But this war, I think it is different because of the highly populated area in Gaza is 2.2 million. Despite that, many hospitals were pushed out of service in a systematic way in order to push the people to go South Gaza. But even those people being told to go to South Gaza, to relocate to South Gaza, they are not safe because many of the injuries I received in Nasser Hospital

and European hospitals are from the refugees that they were pushed to Rafah area, which they were told it's safe. So, and the second thing, unfortunately, in Aleppo, for instance, I helped in Aleppo and it was under bombardment. But at least it is a wide open area, and we had the opportunity to transfer the patients to the border where there are some field hospitals. So there is a way to do damage control and be able to send the injuries to the border.

Unfortunately, in Gaza, you're on your own. There's a blockade on medical supplies, medical aid, humanitarian aids, let alone the injuries. They won't allow them to get outside. So you have to try your best and treat the patients with whatever you have in terms of resources. This was quite different than the senior war, and that certainly will dictate the large amount of casualties and death in this war. You've dedicated a lot of your time to providing emergency care in war zones, putting yourself in quite risky situations. Why is this important to you? I have been in war zone before.

I know how ugly this would go. And it really break my heart to see the children suffering and to see the medics suffering as well, overwhelmed with no capacity. I know that many surgeons, I met great surgeons in Gaza and in Syria as well, they could have saved lives otherwise, but because of the lack of support of enough medical personnel and medical supplies, they were not able to save as much lives. And this is what really motivated me. I figure we have to help our colleagues. We took the oath to save lives and, you know, help the patients wherever they

are from any background or, you know, religion. And, you know, I feel it's our duty to go and help the colleagues, the nurses, the doctors in Gaza. I think Gaza has shown the worst of humanity for the last three months with a lot of children casualties and death. But it did show at the same time some great moments of heroism because of the medics, doctors, and nurses working tirelessly day and night. And I felt it's our duty to give them a hand even for a couple of weeks. Are there patients that you think about now that you've been back for a few days? Are there patients who stay in your mind? Yeah, I mean,

many patients actually, particularly children, stay in my mind in terms of those who we were not able to save just because of lack of enough resources. Otherwise, we could have saved their lives. But we had great stories that you feel you're rewarded to take care of these patients. And we saved a lot of children's lives. to take care of these patients, and we saved a lot of children's lives. One of them was a child who was in a house by his family moving from northern Gaza to Rafah area, and they were hit by an airstrike, and they rushed that child to a European hospital, and he had a shrapnel going through the upper chest. And we did a quick CAT scan and showed the shrapnel

is just beside the left atrium of the heart. And I had a great British surgeon that I really trust, and I trained with Dr. David Knott in UK. And we had NET, fortunately, that night. I was able to communicate with him, and he gave me some good advice. He said, Anas, you have to go in quickly, and I think this is salvageable. Don't give up. So I had a great thoracic surgeon from Canada with me, and we did the surgery, and we evacuated a huge amount of blood around the heart, and we were able to take the shrapnel and stop the bleeding, and we saved his life. The family, although you won't see anything more than, you know,

some canned food in Gaza, but they brought me some nuts and juice, and I don't know where they got it from. Once we finished the surgery, I'm sure they had to pay a lot of money to bring that juice as an appreciation. They were so happy, so appreciative. And, you know, again, saving one life to me is just great. Will you be going back? Absolutely. Without hesitance, you know, I'd love to, if WHO would coordinate another mission

for me, I'd love to go back. My heart is still in Gaza. It's a beautiful place, great children, suffering for three months and abandoned by the international community. I think it's our duty to help these children. Anas, thanks so much for taking time to come on. Thank you so much

for having me, Damon. That's all for today. I'm Damon Fairless. Thanks for listening to FrontBurner. I'll talk to you tomorrow. For more CBC Podcasts, go to cbc.ca slash podcasts.