'Agony and pain': US health professionals reflect on the Gaza war

The memories keep him awake at night. All it takes is for a mobile phone to buzz or an aeroplane to fly low overhead, and his mind snaps back to Gaza, where warplanes streak through the sky and low-rumbling drones herald impending attacks.

Omar Sabha, 44, of Orange County, California, only spent 10 days in Gaza. But what he and other American medical personnel experienced there has left them grappling with the scale of the humanitarian disaster unfolding.

Gaza has been under an Israeli military assault since October last year. More than 37,900 Palestinians have been killed, and another 87,000 have been wounded, straining a healthcare system already in tatters.

And then there are the allegations of human rights abuses. When Sabha first crossed the Gaza-Egypt border in April, he told Al Jazeera he was plunged into a chaotic scene.

Trucks were everywhere. People scrambled to collect their bags. And in their midst, Sabha noticed a man carrying eggs, a seemingly odd sight. He later found out that the man worked for World Central Kitchen, a nonprofit delivering food to hungry Palestinians.

That was the last time Sabha saw the man and his team alive. “They left 20 minutes before I did,” he said. “Forty minutes after we got to our hospital, they were brought in dead.”

They were the first corpses Sabha saw on his arrival at Al-Aqsa Martyrs Hospital in Deir el-Balah, south of Gaza City.

Israeli forces had bombed the aid workers’ convoy — something the Israeli government described as an accident but rights groups called a possible war crime.

To this day, Sabha is still haunted by the pulse of the airstrikes he heard. “That sound never goes away in my head,” he said.

A bald, round-faced father of two with a warm smile, Sabha had been looking into a career change when he decided to become a registered nurse. He previously served in the United States Marine Corps and owned a gym.

Sabha’s entry into medicine coincided with the start of Israel’s war in Gaza. On October 7, 2023, the Palestinian group Hamas launched an attack in southern Israel, and Israel responded with a declaration of war.

Less than three weeks later, on October 23, Sabha graduated from West Coast University in California with a degree to be an operating room nurse.

But news from his extended family in Gaza interrupted the happy occasion. An Israeli drone strike had killed some of his relatives.

“An hour after I graduated and passed my exams, my second cousin’s building got bombed and 20 of them were murdered,” Sabha said. “I was overwhelmed with guilt, grief and [was] just upset.”

He ultimately decided to volunteer with Humanity Auxilium, a healthcare nonprofit providing medical relief in conflict areas, as well as regions affected by natural disasters.

Sabha arrived in Gaza just as his younger brother Mahmoud Sabha, 39, was concluding a mission with the same organisation. Their stay overlapped for a couple of days.

A physician based in Texas, Mahmoud had left the US in March, knowing the trip to Gaza came with risks.

As of May, the Ministry of Health in Gaza reported that more than 493 healthcare workers have been killed in Gaza since October 7. Another 214 have been detained by Israeli forces, according to the World Health Organization.

The Israeli military has also carried out more than 400 attacks on healthcare facilities in the area. It has admitted to conducting air strikes on ambulances and clinics, which rights groups warn could constitute violations of international humanitarian law.

Israel, however, has denied wrongdoing, saying it was targeting Hamas fighters.

For Mahmoud, confronting the dangers for medical personnel in Gaza meant preparing for his own death before his departure.

“We made sure we completed [the will] before I left, because there was always a chance that you might get bombed or get stuck there,” Mahmoud said. “We knew there was a possibility of dying.”

When Mahmoud crossed paths with his brother in Gaza, similar fears flashed across his mind.

“When I left, I started being nervous for him, even though I was just in that position a few days ago,” Mahmoud said. "I was wishing I was seeing him for longer.”

But Sabha did not arrive in Gaza alone. He travelled with his friend, Jawad Khan, a 40-year-old orthopaedic doctor specialising in hand surgery.

The two men shared a room during their stay in the Palestinian enclave, and they often confided in each other about their experiences.

Unlike Sabha, Khan was on his third volunteer medical mission, having previously served in the West Bank city of Ramallah in 2012 and 2017. But this trip marked his first time in war-torn Gaza.

“It was just a very surreal feeling,” Khan said. “You felt the signs of the war right away.”

Khan still remembers his first case like it was yesterday: He had to treat an eight-year-old girl who had been shot in the arm.

She had been playing with her sisters when Israeli drones shot all four of them. One died, and two were shot in the leg, Khan said.

“It resonates because I have a daughter the same age," Khan added. He estimated that more than 75 percent of the people he treated were children, under the age of 18.

Meanwhile, in his role as a nurse, Sabha assisted with surgeries, often performing amputations. The most common injuries he encountered were life-threatening wounds from shrapnel.

“I was scared at first. I was scared of the drones, the bombs and everything. But then you look around and you see everybody,” Sabha explained. “You get the courage from that.”

Even the constant rattle of air attacks started to feel comforting: “The bombs come and that shakes the building. If you hear it, that means you're alive.”

Sabha and Khan also said they helped each other cope with the horrors, by talking through what they had seen.

“I think with those conversations, you know, we were both able to really process our emotions,” Khan explained.

The hospital where Sabha and Khan were stationed was also feeling a strain. Though it was designed for 200 people, it housed more than 10,000, according to Sabha.

Many patients were suffering from severe injuries. Others faced amputations. Few had anywhere else to go.

Sabha recalled that there was only “one bathroom for every 200 to 300 people”. Doctors, meanwhile, had to improvise emergency room (ER) settings.

“When patients come into the ER, they don't have a bed for them. They’re seeing them on the ground," Sabha said. "In that hospital hallway, you're always jumping over someone's leg, over a body.”

Sabha remembers seeing 20 to 30 patients each day — all while fasting for the holy month of Ramadan. A practising Muslim, he survived on four hours of sleep and approximately two protein bars a day, he said.

But the volume of patients did not just tax the hospital’s limited space: It also stretched resources thin. Gaza has been under a heightened siege since October 7, with food, water and medical supplies scarce.

That meant Sabha and Khan had to work with limited medications and instruments.

“We definitely had to be very creative and get out of our comfort zone,” Khan said. He explained that, in normal circumstances, “when we fix fractures, we use certain types of screws, certain types of plates, certain types of rods".

But in Gaza, “we kind of had to use the wrong implant to fix something because that's all that was available”.

The health situation was made all the more dire by Gaza’s crumbling infrastructure. Constant bombings had left buildings weakened and unstable, and the lack of sanitation facilities bred rampant mosquitoes.

"There is no sanitation system there right now. The garbage is just piling up. So that smell is kind of around everywhere,” Khan said.

“Imagine you walk by a junkyard. It wasn't a pleasant smell.”

Even now, months after his experience, Sahba is struggling to come to terms with the situation in Gaza.

“Agony and pain all the time. And I'm telling you, the scene was surreal. I have a hard time getting that image out of my head because it's so vivid,” he said.

He remembers breaking down and crying in his hospital room after treating patients. One eight-year-old child named Dana arrived with burns covering about 70 percent of her body, he said.

As he continues his career as a nurse in the US, he still experiences flashes of the bloodshed he witnessed.

When he washes his hands with the antiseptic Betadine to sterilise himself before entering an operating room, the smell transports him back to Gaza. The same thing happens when he catches a whiff of burning flesh while cauterising wounds.

“For the first couple days I was back in the hospital, [it was] very traumatising for me,” Sabha said. “It was extremely hard for me.”

At first, he didn't realise the toll his visit had taken on him. However, he has since decided to seek counselling.

"I am going to get professional help for PTSD [post-traumatic stress disorder]," he said, adding: “I’m very depressed. I cry all the time.”

But he hopes that, by sharing his experiences with others in the US, he can help advocate for a ceasefire in Gaza. The US, after all, is Israel’s biggest ally, providing $3.8bn per year in military aid to the country.

Sabha added that the trip ultimately helped put his own life into perspective.

“I learned to not let small things bother me, not to let anything bother me, because it could always be worse. I learned to be more patient,” he said. “I learned to be more resilient, and I became a better Muslim.”