Surgery without anaesthetic: a Gaza hospital on the brink

The treatment of Omar Ahmed, who was injured in an Israeli strike, at the Nasser hospital in Khan Younis, southern Gaza, is the story of a medical system close to collapse.

During Ahmed’s five days on the ward, he has never had a moment without pain. His burns were cleaned without anaesthetic and he was left to recover with painkillers that “are not strong enough”.

The overcrowded room that Ahmed, 25, shares with five other serious burns victims experiences power cuts for long periods of the day. Without cooling, the heat made him sweat, which he said inflamed his wounds.

His stay may be cut short. “The hospital asks people to leave when they are 60 or 70 per cent cured,” said Ahmed, whose leg was also broken in a blast while he was attempting to flee northern Gaza. “I don’t know what I would do if I had to go.”

The 350-bed Nasser hospital in Khan Younis is no outlier. After three weeks of heavy Israeli bombardment, medical services in Gaza are on the brink. But exhausted staff are doing what they can with the fast-dwindling resources.

Israel has cut off mains electricity to Gaza and the Nasser hospital is low on fuel for its generators. Medical supplies are also running out. Surgery is sometimes performed without routine anaesthesia, according to doctors. The priority is to keep stocks in reserve for difficult cases.

“We have performed C-sections on pregnant women who were injured in the bombardment without anaesthesia and we have also had to clean up severe burns without it,” said Nahhed Abou Taima, director of the Nasser hospital. “We are extremely short [of supplies].”

Taima fears that the fuel needed to keep the hospital generators going is also running low. “We need between 200 and 300 litres every hour. We get what we can from petrol stations but we can run out any minute,” he said. The generators, which are now used 24 hours a day, are also at risk of breaking down.

About 2.3mn people are packed into Gaza living under what UN officials describe as disastrous humanitarian conditions. Ashraf al-Qudra, spokesperson for the health ministry in the Hamas-controlled enclave, said 12 hospitals and 32 medical facilities have been shut since the conflict started this month.

“The fact that hospitals remain open does not mean they are capable of offering services to the floods of injured and sick people who go there,” said al-Qudra.

Israel has also issued evacuation orders for some hospitals — including Dar al-Shifa in Gaza City — that are still running, claiming that the medical sites are used by Hamas as military staging posts.

Médecins Sans Frontières, the international medical charity, described the demand made on an already overwhelmed hospital system as “impossible and dangerous”.

The International Federation of Red Cross and Red Crescent Societies said it was “deeply alarmed” by reports that medical teams at al-Quds hospital in Gaza City had been ordered to immediately evacuate the hospital.

“Evacuating patients, including those in intensive care, on life support and babies in incubators, is close to, if not impossible in the current situation,” the IFRC said. “Our teams also report violent attacks and shelling very close to the hospital, further endangering people.”

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More than 8,000 Palestinians have been killed by Israeli strikes on Gaza, according to the Hamas-controlled health ministry. Israel launched the retaliatory strikes after Hamas militants led an assault on October 7 in which at least 1,400 Israeli civilians and soldiers were killed, according to the government.

At the Nasser hospital, ambulances arrive around the clock to deliver the wounded to the emergency entrance. The department is so overwhelmed that doctors treat patients on the floor and in corridors. Many are covered in dust and ashes after being pulled out from the rubble of their bombed homes.

Adults carry in wounded children crying or shaking from shock. There are terrible scenes of anguish as bereaved families learn of the death of relatives. The badly injured scream with pain.

During Israel’s heaviest night of bombing on Friday, communications were cut across the territory. Ezzeddin Mekheimar, an ambulance staff at Nasser hospital, said delays in reaching injured people on that night “definitely added” to the number of deaths.

“We just headed in the direction of smoke plumes or fires, without even knowing if there were injured people,” he said. “Sometimes people who brought the wounded in private cars told us where to go.”

Ashraf al-Shanty, another paramedic, said nothing he had experienced in past conflicts had been as intense as this war. “We go to places that have been bombarded to find entire families killed or injured,” he said.

Taima, the Nasser hospital director, said they have had to squeeze in an extra 100 beds to cope with the flood of injured people. The surgery department has also been expanded at the expense of other services. “Eighty per cent of our beds now are for surgery,” he said. “There isn’t a single empty bed.”

The hospital has also had to expand its intensive care department to accommodate those with severe injuries. “Anyone who comes now with a heart attack has to be treated in an ordinary room without the necessary equipment,” said Abd Rabbo al-Atrush, the head of the intensive care unit. “There is a huge volume of work and not enough doctors,” he added.

With essential equipment and supplies — such as ventilators, medicine, anaesthesia, antibiotics, medical solutions and blood — increasingly scarce, al-Atrush acknowledged that the hospital could no longer treat every injured person seeking help.

“We have to make a decision on who to treat fast,” he said. “We cannot deal with difficult cases or where there is no hope of saving a life. It is a very tragic situation — catastrophic in the full meaning of the word.”