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Kevin ClarkeMay 16, 2024
A Palestinian boy wounded in an Israeli strike waits to receive treatment at a hospital as Israeli forces launch a ground and air operation in the eastern part of Rafah, amid the ongoing Israel-Hamas war, in Rafah, in the southern Gaza Strip, May 7, 2024. (OSV News photo/Hatem Khaled, Reuters)A Palestinian boy wounded in an Israeli strike waits to receive treatment at a hospital as Israeli forces launch a ground and air operation in the eastern part of Rafah, amid the ongoing Israel-Hamas war, in Rafah, in the southern Gaza Strip, May 7, 2024. (OSV News photo/Hatem Khaled, Reuters)

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With more than one million displaced Palestinians staring famine in the face last week, it is hard to imagine that conditions could get any worse in Gaza. But they have. That is the sobering assessment shared by Jason Knapp, speaking from Jerusalem on May 15.

Mr. Knapp is the country representative for Jerusalem, West Bank and Gaza for Catholic Relief Services. He explained that before the Israel Defense Forces moved into Rafah, seizing and closing the border crossing into Egypt on May 7, C.R.S. team members had at least been able to maintain a fairly well-running aid program in a former supermarket in Rafah that was supporting hundreds of Palestinian families.

That operation has been shut down entirely after the I.D.F. ordered the evacuation of the entire area. C.R.S. team members and staff from partner agencies like Caritas Jerusalem are enduring yet another dislocation, like the rest of the community in Gaza.

Evacuations ordered in Rafah

Some staff members have been uprooted as many as eight times since the conflict began in the aftermath of a Hamas-orchestrated massacre in southern Israel on Oct. 7. This week’s attempts to relocate the C.R.S. aid distribution to central Gaza have already been disrupted by more evacuation orders from the I.D.F.—this time in the north, where hit-and-run attacks by Hamas militants reignited combat hotspots in neighborhoods previously under I.D.F. control.

I.D.F. officials describe Rafah as a final Hamas redoubt in Gaza, brushing off warnings from the United States and other allies that any major operation there would be catastrophic for civilians. More than 1.3 million Palestinians had crowded into Rafah in recent months, fleeing northern and central Gaza camps and communities in response to prior I.D.F. evacuation notices.

Now United Nations officials report that at least 600,000 people have fled Rafah since May 7, and more than 100,000 may be on the move in central and north Gaza because of new evacuation orders as the fighting continues.

No food has entered the two main border crossings in southern Gaza for the past week. Some 1.1 million Palestinians face catastrophic levels of hunger, according to the U.N., and a “full-blown famine” is taking place in the north.

C.R.S. and other humanitarian agencies at this point are essentially unable to get any aid to the repeatedly displaced people of Gaza. Everyone is facing the same questions, Mr. Knapp said, wondering where they can find a safe place to shelter and for how long.

Gunfire and explosions from tank fire, artillery and missile strikes sound around Dr. Mohamad Abdelfattah just about constantly, but the doctor, stationed “in the bubble” of Gaza’s European Hospital in Khan Younis, believes he is relatively safe—or at least as safe as anyone can be anywhere in Gaza. Dr. Abdelfattah and the other volunteer medical staff from the Palestinian American Medical Association live on the hospital’s grounds and have been advised not to venture beyond the compound.

Back home in Southern California, Dr. Abdelfattah is an intensive care unit specialist. Tired of watching the suffering in Gaza from the sidelines, he felt compelled to put his medical skills to work filling the gaps in Gaza’s devastated health care infrastructure. Dr. Abdelfattah is part of a team of medical specialists who had been rotated into Gaza on May 1 by PAMA. The rotation was supposed to end on May 13, but now, with the border closed, he and the other volunteers are unable to leave.

His work in the United States did not prepare him for the kinds of trauma cases he has encountered at the emergency room in Khan Younis over the last two weeks. “We’re seeing a lot of explosive injuries, which present with severe shrapnel injuries, requiring limb amputations. We’re seeing a lot of burn injuries—60, 70, 80 percent of total body burns.”

For this young father of two small children, “the most distressing part of all of this has been the fact that most of the victims are children, very young age children.”

On his first day in the E.R., he treated a 6-month-old infant. “Her foot was completely sliced open and she was screaming.” Next to her was an 18-month-old toddler with a shattered arm “just wailing for his dad.”

The hospital’s capacity to deal with extreme injuries has been seriously diminished after seven months of war. “Severe burns require very close monitoring and a lot of critical care and attention. Even in really sophisticated burn centers, there’s a high mortality with burns of this degree, so here, it’s pretty much guaranteed death,” Dr. Abdelfattah explained.

He reports that “100 percent” of the patients that he has been treating in Gaza have been civilians. “There have been no fighters.”

Wounds that cannot heal

A wound-care specialist, Dr. Mahmoud Sabha is on his second tour in Gaza. A PAMA volunteer from Dallas, he has also encountered complications never before experienced in his professional life. Gaza infrastructure has been obliterated after months of bombing. Children are being treated for deep infections after open wounds were splashed with raw sewage that runs through the makeshift encampments in Khan Younis.

“It’s very normal to see maggots coming out of the wounds because the flies are everywhere,” he said. Serious wounds go untreated because combat conditions around the hospital prevent the injured from venturing to its emergency room.

Because blast trauma often causes compound fractures, bone infections are common. Many of the wounded would most benefit from lengthy hospital stays with antibiotic I.V.s, Dr. Sabha said, but that kind of treatment is far from realistic at this time.

Above all else, he said, people with the kinds of serious wounds that he is treating cannot heal without the proper rest and nutrition, two commodities in short supply in Gaza. Refugees who had been sheltering on the hospital grounds are on the move again this week, he said.

“My main concern now is preventing further infection,” he said. “That’s number one, and then I can start seeing what we can do to close the wounds.”

He points out that the war has taken a particular toll on the weakest members of the Gazan community, the disabled or people with chronic medical conditions who now have no hope of treatment or reliable pharmaceutical supplies. He has been trying to assist one man with paralysis who had been carried around Gaza by his brother as the fighting approached. Unfortunately, that family caregiver was killed in a recent bombing, and now his patient has no one to assist him the next time an evacuation order comes through.

Being away from his family and now being unsure when he can return home has surely been a burden, Dr. Abdelfattah said. But this week, as PAMA works with the State Department to extract its team from Gaza, “the hardest part is just knowing that this is all a man-made disaster,” he said.

“It’s not like it’s a natural disaster. This is all very intentional,” Dr. Abdelfattah said. And more frustrating is “seeing the injuries that are occurring because of American weapons, American bombs, American bullets, continuing every single hour here with no end in sight.”

With so many critical cases to attend to in the I.C.U., “the monitors are consistently alarming,” and after months of war, the regular staff at the European Hospital are exhausted. Supplies are low and medicines typically available to Dr. Abdelfattah in the United States, particularly those meant to relieve pain among the severely injured, cannot be found.

An evacuation to Egypt does not seem possible at this time. Even a well-marked U.N. humanitarian convoy came under fire on May 13, and a U.N. official was killed. Dr. Sabha stressed that he and the rest of the PAMA volunteers were unwilling to leave if it meant the European Hospital team and the people sheltering on the hospital grounds would be left without the medical support they desperately need. They are prepared to stay, he said, until they can be properly relieved.

“We’re assuming as we leave, others will be able to come in. That’s what we were hoping for,” he said. “We have a team in Cairo right now waiting to come in as soon as they hear word that it’s safe to come in.”

A final fight in Rafah?

As grim as conditions have become, Mr. Knapp knows they could get even worse if the I.D.F. campaign in Rafah accelerates. He welcomes prayers for peace but also urges that the U.S. faithful be prophetic as the catastrophe in Gaza continues.

Mr. Knapp joins other C.R.S. officials, the U.S. Conference of Catholic Bishops and Pope Francis in urging a halt to the violence so that humanitarian agencies in Gaza can safely go about their work. “I really do hope that there is restraint, and we can soon start seeing ways for people to rebuild their lives and hope and a future, as opposed to more destruction,” he said.

The people of Gaza have had enough, Dr. Abdelfattah said. “They’re exhausted. A lot of them have lost their homes. Many of them have lost family members, and they need this to end. We need a permanent cease-fire yesterday. I don’t understand why our president is dragging his feet, why he’s not putting enough pressure on the Israeli government to end this.”

The two doctors spoke about conditions at the hospital on May 14, celebrated by Israelis as national Independence Day. The following day, May 15, Palestinians commemorate the Nakba, or “the catastrophe,” a day when hundreds of thousands of Palestinians fled the fighting that led to the founding of the State of Israel, becoming lifelong refugees in their own land.

The Biden administration told key lawmakers on May 15 that it plans to move forward on a new $1 billion sale of arms and ammunition to Israel. Another arms transfer, consisting of 3,500 bombs of up to 2,000 pounds each, had been put on hold this month. The Biden administration, citing concern for civilian casualties in Gaza, said it interrupted that weapons transfer to discourage Israel from using high-explosive munitions in its Rafah offensive.

In seven months of fighting the United Nations, citing Gaza’s Ministry of Health, reports that more than 35,000 people have been killed in Gaza. On May 16, Israeli Defense Minister Yoav Gallant announced that more Israeli troops were on their way to Rafah.

With reporting from The Associated Press

More from America Media

A Deeper Dive

Correction (May 16): Yoav Gallant is the Israeli defense minister, not its foreign minister as he was previously identified.

Correction (May 21): The Palestinian American Medical Association was previously misidentified as the Palestine American Medical Association.

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