Inside Gaza's ‘meat grinder’: An interview with Dr. Ghassan Abu Sitta

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A Palestinian medic carries the body of a child, killed in an explosion in a public playground on the beachfront of Shati refugee camp, in the morogue of al-Shifa hospital in Gaza City on July 28, 2014. (Photo: AFP-Marco Longari)

By: Yazan al-Saadi

Published Monday, August 18, 2014

Ghassan Abu Sitta is no stranger to war and calamity. He has been to Palestine multiple times during major crises, working first as a medical volunteer during the first and second intifada, and then as a surgeon for al-Shifa Hospital in Gaza during the three brutal wars perpetrated by Israel, the latest of which was launched last month.

Abu Sitta, 45, is a reconstructive surgeon of medium height and has a matter-of-fact yet genial tone. He comes from a town in the south of occupied Palestine that was ethnically cleansed of its indigenous population by Zionist forces in 1948. It is called Bir Saba'a, commonly known today as Beersheba.

Born in Kuwait and having spent most of his medical training in the United Kingdom, he decided to move to Beirut just three years ago, and was quickly promoted to head the plastic surgery department at the American University of Beirut Medical Center (AUBMC) a year later.

His short-term medical volunteer work in Palestine is facilitated through a small British charity called Medical Aid for Palestinians (MAP), an organization that he has been involved in since his time as a medical student 26 years ago.

Al-Akhbar English sat down with the surgeon last week, two days after he returned to Beirut, to speak about his experience of being in Gaza and working at al-Shifa Hospital.

Yazan al-Saadi: Tell me about this latest trip. Describe the process.

Ghassan Abu Sitta : From the start of the [2014] war, we realized that this is going to be a long drawn out conflict. From the start, we tried to get in through Egypt which is how I entered in 2012 and 2008. [We tried] through every way possible [but] it was impossible, this time we couldn't get in.

YS: How do the restrictions compare to 2008 and 2012?

GAS: In 2012, I was in Rafah for two hours. [In] 2008, I slept at Rafah for two days and then I got in. This time it wasn't happening. They were turning teams back all the way. They hadn't allowed a single medical team in.

YS: Did they give you a reason?

GAS: The border was closed, and that was it.

From the start, one of the avenues MAP was pursuing was through the World Health Organization (WHO). The WHO had identified the fact that there was such a shortage of surgeons, that the Egyptians and Israelis were not allowing any of the patients out and that a lot of the treatment had to happen inside [Gaza]. Two weeks into the conflict, I suddenly got an email from them that said I was granted a permit. It took me 48 hours to sort out my patients and schedules, and I went through Jordan into the West Bank, and across the West Bank into Eretz crossing.

YS: How was the experience going through Eretz, were there any problems with the Israelis?

GAS: The problem with the Israelis was at the Allenby Bridge [the bridge crossing that connects Jordan with the West Bank]. They interrogated me for three hours and then they kept me waiting for a further six hours before they gave me my passport back.

When we got to Eretz, it had been under rocket attack so it was closed for a while and then they just waved us through just because they wanted to close it down.

I got in by midday and went in that night to al-Shifa Hospital. The plastic surgery department has a separate building within the Shifa complex. It is a burns unit. It was built by a Palestinian philanthropist named Adnan Alami. I've worked with them in the past, so I got in that night, saw everybody, sorted out the schedule, and started operating the following day.

YS: Can you describe how the hospital looked when you got there?

GAS: It looked like a refugee camp. The campus of the hospital has a lot of the families that escaped the bombing or lost their houses and they were living inside the walls of the hospital. Everywhere you go you see makeshift dwellings made out of laundry lines and bed sheeting turned into tents. And the hospital was completely full. Single rooms had four beds in them. In some wards we had two patients per bed.

The difference between this conflict and the one before is that nobody was allowing the patients out. So you had 7,000 injured – at the time I was there it was 6,000 and by the time the conflict ended the injured were 10,000. An overwhelming majority have still not been able to get out of Gaza. There have been some numbers, but not significant numbers to break the back of this problem. From the day I went to the day I left, I was doing around five to seven surgeries a day. I would start work at 8:30 in the morning and finish at around seven in the evening.

YS: How was the morale of the staff?

GAS: The staff have to cope with their own personal problems. Some of the staff had lost members of their families, some of the staff lost their own homes during this attack. And the ones that haven't, have six or seven families living with them. They were exhausted even when they went home. And there was water shortages, electricity cut outs. So the staff were coping brilliantly with very difficult circumstances.

YS: How does the hospital deal with the water shortages or electricity cutouts? What were the contingency plans?

GAS: The contingency plans were that all diesel was kept for the al-Shifa Hospital, so people did not have electricity at home, they would donate the diesel to the hospital. The wells that supply Shifa, like the rest of the water in Gaza, had become so contaminated with sea water, it's salty. People do the best with what they have.

YS: In regards to the surgeries, what type of injuries were you dealing with?

GAS: Either burns or blast injuries. Blast injuries can be either from the blast itself – the explosion – or the shrapnel from the casing of the explosives or the shrapnel from the debris that the explosives causes or buildings collapsing on top of people.

YS: Did you deal with any abnormal injuries?

GAS: There were some injuries that I had seen in 2008, especially related to DIME [Dense Inert Metal Explosives]. Basically, in an explosion the limb is amputated at the weakest point – the joints. With DIME, the limb is amputated at the level of the mid-thigh, which is really the strongest part of the limb. In addition, those who are further away have multiple lentil-sized shrapnel, some inside the cranium and elsewhere.

The problem is that after 2008, when we started looking into this, all the evidence, all the lab evidence coming into the US shows that this tungsten material, the shrapnel, is carcinogenic – it causes cancer.

But the majority of the killing was happening because they were dropping ammunition designed to penetrate mountain caves. [The Israelis] were dropping them on civilian dwellings made out of breeze block. And so these four or five storey buildings were being pulverized by these one-ton bombs. That was what was wiping out whole families. And in Gaza, because land is so much in shortage, people come along and build their house, they build enough foundations that when their kids grow up, they can build a floor on top. So when you take out a four storey building, you take out four generations of a family. That was what happened to, I think, 60 families that have been completely wiped out.

YS: Going back to the injured, you saw a lot of DIME injuries. Can you describe the type of injuries they are?

GAS: They arrived amputated. We had five or six [cases] when I was there. In the beginning of the war, there were more. But we shouldn't get side tracked with the issue of these weapons. Murder is murder. It doesn't matter what they were using, they were using weapons against civilians, with the intention of killing civilians.

To give you an example, they started inventing these humanitarian ceasefires, where people would go out and they would start killing them. We had this on the day of Eid, they said there was a humanitarian ceasefire and the kids went out to a local fair ground and they bombed them. The other time was in al-Shujayeh market, there was a humanitarian ceasefire, they got them into the market, they killed them, then they waited for the ambulances to get there, and then they shelled the ambulances again.

So the issue isn't the type of weapons, but the intent to kill. The amount of ordinance they used and the tonnage of the bombs they used were intended to wipe out whole neighborhoods. That's what they have done. They have completely wiped out Shejayeh, they wiped out Khuza'a, they wiped out a big part of Rafah, a big part of Khan Younes, and parts of Beit Hanoun.

YS: How were the sentiments of the people you talked to? The patients, the staff, the public?

GAS: People were adamant that they were not going back to the siege, that eight years had eaten into the life of a whole generation. They were prepared to fight on, even with the costs, but they were not going to die slowly and silently with the siege. Every time you needed minor operations you had to wait to get a permit to get out. Any time a piece of equipment would break down, we had to wait months and months. Any time UNRWA wanted to build a school, the waiting time was 36 months for the Israelis to give UNRWA construction material.

That was the cause, and that is why there was such unanimity with the public population about this war, and that was what caused this cohesiveness. Even now, before I left during the ceasefire, people were saying that if they weren't going to lift the siege, they were going back to resisting.

YS: In terms of the patients you were dealing with, what were their ages?

GAS: By definition, the elderly do not survive these kind of injuries, so it was the young. There were a disproportionate number of children. A disturbing number of children. I would say that 80 percent [of patients] I operated on were children, under the age of 15. The rest were young people, women and men.

YS: How were the children after the surgery? Is there a mechanism to cope and therapy?

GAS: At the moment there is no mechanism. The majority of these kids ended up with permanent disabilities or permanent deformity. And a lot of these kids were dealing with grief because they lost someone. To add that to the disability. And there is a big number of children who lost everyone, and there is no one else to care for them after the war. They were the sole survivors of their family.

YS: Other than the fact the patients cannot leave, how does this war compare to before?

GAS: It is much more severe. It was like a meat grinder.

YS: How so?

GAS: The amount of ordinance that the Israelis fired, the indiscriminate use of these bombs that are capable of bringing down whole buildings, the use of artillery shelling which is indiscriminate because the shell will hit the first thing it reaches, the fact that they were attacking from the air, from the sea, and by land with artillery at the same time. And there was a night they were doing this and then they lit all of Gaza's sky with these flares just so people will know that this is what's happening.

I think there were two aims [for the Israelis]:

The destruction of huge parts of Gaza, aimed at creating such a demographic crisis. I mean, when you make half a million, out of a 1.8 million, homeless, you create a demographic crisis. That, the Israelis expected, would cause internal collapse. But the Israelis did not take into account the amount of social cohesion and social networks that people had. Most of the people I knew who still had their homes had five or six families in their homes, people that they didn't even know. They were not relatives. I think that prevented this demographic crisis from happening – people opened up apartments that they owned and were empty, private institutions such as nurseries and kindergartens opened up their institutions for families to live in, UNRWA opened up all of its schools, and the Ministry of Education opened up all its schools for families to live in.

The other aim of the destruction, regardless of who comes to rule Gaza – whether it is the national unity or the coalition government or technocrats or the Palestinian Authority or Hamas – is you will be stuck for 10 years dealing with the destruction and trying to provide for people. To incapacitate society with the sheer amount of people left with permanent disabilities.

YS: Were you scared?

GAS: Look, they bombed Shifa once, and then again they threatened to bomb a new building in Shifa that hadn't been completed. Because of the pressure of the beds in Shifa, we moved beds and a lot of patients into it to try and decrease the load. They threatened to bomb that and ICRC was informed by the Israelis. So we had to evacuate the patients. I was worried because if that had happened – if they had bombed that building – it would have been carnage.

YS: Were you there when they bombed Shifa the first time? Can you describe that experience and what happened?

GAS: Yes, I was there. The problem is that Gaza is so densely populated. You don't know where it hit until they told us. All the areas around the hospital were being bombed all the time. You would hear it. We heard something we knew it was close, but didn't know how close it was. We then got a call to the emergency room and we were told that the administration and the out patients building had been hit – a lot of families had taken refuge in that area – so we had to go and help.

YS: Were Hamas and other Palestinian factions shooting rockets from around Shifa's vicinity?

GAS: Around Shifa? No, no, no. But in other places you would see them in the sky or hear them. You would learn to distinguish the whoosh of the rocket. Gaza is so small and so flat, I mean you are not going to hide them in the mountains or the jungle because there are no mountains or jungle. People are literally on top of each other. It's going to happen. But around the hospital there were none.

YS: So the first shelling of the hospital had no justification?

GAS: None. The first shelling, the Israelis said that they were trying to kill some of the politicians that were coming to do TV interviews around Shifa Hospital.

But you are so hyped up and at the end of the day you are so tired, that I remember sleeping through several air raids just out of sheer fatigue.

YS: Where were you sleeping?

GAS: Our family home, my uncle's house, which is close to Shifa. I opened it up. It's empty now because my uncle and his wife passed away, but I opened it up and stayed there just because I needed to put distance between myself and the hospital.

YS: How are you coping? Do you have any issues, or is this something that you've hardened up to over time?

GAS: On a certain level, I am overwhelmed with sadness. I can't see how people are going to get out of this. The amount of pain and suffering that there is. The bleakness and suffering in the short or medium-term. Unless the borders are opened up, unless the houses are rebuilt, unless the patients get the right treatment.

On another level, I can't imagine having not done this. I think this is going to be a pivotal moment in Palestinian history.

YS: Can you elaborate?

GAS: The fact that the Palestinians were able to fight off the Israeli land offensive. The fact that the children and grand children of Palestinian refugees took the battle back to Lod, Yaffa, Bir Saba'a for the first time since 1948. The fact that the Israelis are now incapable to expand north and now are incapable of expanding south is critical.

As tough as it was, I'm grateful for the opportunity. This was an important moment for Palestinian history. As painful as it is, it is going to change the face of the Palestinian cause.

YS: In regards to what's next, are doctors documenting injuries and sending information to the WHO or international organizations for the sake of possible accountability?

GAS: At the bare minimum, the three attacks on UNRWA schools that were housing refugees, the executions that took place in Khuza'a, the taking of children as human shields in Khuza'a by Israeli special forces, the targeting of children in the fair grounds and on the beach...the issue of the accountability was never about the detail, but who was held accountable, and that is not going to falter on the details, it's going to falter on international will.

There was full documentation and human rights groups on the grounds working to document and take full affidavits. They learned from the mistake of 2008 inside the hospital where documentation was very poor, and a lot of information was lost.

The problem is that, let me give you an example, when they hit al-Shujayeh market, we had 240 patients arrive within 45 minutes. Ambulances had seven or eight stacked on each other. The toktoks [three wheeled motorized vehicles usually used as taxis] were bringing people. The taxis and cars were bringing people in. At that point, you are barely keeping up with the dead, and I think that was an issue.

But I think the documentation hopefully will help, but it hinges on international will.

YS: One of the things the Israelis announced, and they seemed very pleased by this announcement, was that they didn't use white phosphorus this time.

GAS: They didn't use phosphorus expect on a small scale in al-Shujayeh.

YS: So they did use phosphorus?

GAS: They did, on a small scale, but I didn't see any casualties. Again, it's not about unconventional weapons it's about the conventional weapons. When you admit to using 30,000 tons of ammunition on Gaza, a place as crowded or as small as Gaza, it doesn't matter if it is phosphorus or DIME or anything else. It is a crime.

YS: What do you except of the future, if another war breaks out –

GAS: When another war breaks out. Not if.

YS: When another war breaks out, are you ready to go back in?

GAS: Yes. This is what I do. It is less painful than sitting and watching it from the couch.

YS: Are your family afraid for you?

GAS: My wife accepts this is the right thing to do. My mother, being a parent, is much more worried about it. My family are worried about it. But you know, after I turned 45 and then two weeks later I left to Gaza, they realized that I wasn't going to change. This is the way I led my life and I am going to continue to.



God bless this amazing doctor and everyone around him.

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