Unlike other battle and disaster zones, NGO medical staff in the tiny Gaza Strip put their lives at risk when they work to save lives. One employee describes doctors kneeling on the floor to attend to the wounded and thousands of displaced people sheltering in hospitals
Five-year-old Malak Abu Sa’ada is one of approximately 500 Palestinians who were wounded in IDF strikes in Gaza within about 24 hours last week. At the same time, between the afternoons of Sunday, January 7, and the day after, 249 Palestinians were killed in bombardments, according to figures from the Hamas-run Health Ministry in Gaza.
On Monday morning, January 8, a shell penetrated the building in which Malak and her family had found shelter in the southeastern part of Khan Younis, in southern Gaza. Along with them were sheltering some 100 others displaced from their homes by the bombings and collapse of essential services.
All of them were employees of Medecins Sans Frontieres NGO (aka Doctors Without Borders) and their families; Malak’s father is a driver for the organization. The international organization, established in France in 1971, had housed them in a building close to the enclave’s European Hospital. Besides Malak, three people were wounded and rushed to the hospital. The shell didn’t explode. If it had, the number of wounded would have been much higher, the organization said.
Israel’s constant pressure on Gazans to vacate more and more parts of Gaza is forcing growing numbers of people to cram into a steadily shrinking area in the south. The organization has, therefore, had to take on another role in addition to providing medical care for the sick and wounded: to ensure the secure evacuation of its workers and their families and house them in shelters that are supposed to be safe. Its frustration when these efforts fail is evident in the official statements it releases.
The doctors’ efforts to save Malak failed, and the 5-year-old from the Jabalya refugee camp was added to the list of 126 Palestinians killed in a 24-hour period between the afternoons of January 8 and 9. Photos show her lying on the floor in a hospital hallway, in a red shirt and a blanket covering part of her body. Three other children kneel beside her, saying goodbye.
According to a statement from MSF issued on the day of her death, the organization had told the Israel Defense Forces in advance that its employees and their families were staying in the building next to the European Hospital. Before the attack, the statement said, no evacuation order – the kind that the IDF Spokesman’s Office Unit and the Coordinator of Government Activities publish daily – was issued for the area. ” MSF is not able to confirm the origin of the shell, it appears to be similar to those used by Israeli tanks. MSF has contacted Israeli authorities and is seeking further explanation,” the statement said.
MSF employs around 300 Gazan Palestinians, including doctors, nurses, psychologists, administrators, logistics personnel, and drivers. In addition, several foreign citizens are posted in Gaza to work as specialist doctors and logistics coordinators. Under the severe constraints of war, these number between 10 and 20, and they are replaced at more frequent intervals than before the war, spending but a few weeks in Gaza before leaving. They all currently work in Rafah and live in one of the recreation homes built along the coast over the years, which are now all filled with many displaced people.
Nearly 180 international organizations, including the UN ones, are involved in bringing emergency humanitarian supplies into Gaza. All have some sort of presence in Gaza, says the director of one. The smaller ones cooperate with local organizations or residents who serve as liaisons. Others have salaried workers. The largest and most established organizations also dispatch foreign citizens to work in Gaza alongside local staff.
Doctors Without Borders, one of the largest organizations, also rents buildings near the hospitals in Gaza in which its staff work, in coordination with the local medical authorities, as in every country where the organization operates. During wartime, every humanitarian organization’s employees, local or not, don’t just save lives and provide emotional and material assistance. They also witness the increasingly desperate situation and place themselves in mortal danger. Local employees are also burdened by the constant fear for the lives of their family and friends.
Jacob Burns, a 35-year-old from Scotland, was posted to Yemen in 2021 and served as Doctor Without Border’s project coordinator in Gaza in December. “The difference from Yemen is that in Gaza, there’s nowhere to go. Nowhere is safe,” he told Haaretz shortly before he left Gaza 10 days ago. “In Yemen, usually people can escape from the areas of hostilities and find a relatively safe place. International organizations can also spread out and work there in relative security.
“Here, we’re trying to help people within the combat zone itself,” he says. We report all of our movements to the army via the Coordinator of Government Activities in the Territories.” The military has the GPS coordinates of all the hospitals in Gaza, he adds, “but they’re still not protected”, he stressed. . “Everything is harder and more intense here, and when it’s not even possible to make a phone call, it’s also very hard to provide aid.”
The lack of protection means staff have no choice but to sometimes leave their post. On January 6, the organization had to leave Al-Aqsa Hospital in Deir al-Balah, which until recently was labeled a “safe zone.” Battles raged close to the hospital for about a week. That morning, Israeli planes dropped leaflets in the surrounding neighborhoods, instructing the residents to evacuate immediately. Many of them had already been displaced from areas in northern Gaza and were now forced to move for the second or third time. The organization also evacuated employees’ families from the area.
Meanwhile, at Nasser Hospital in Khan Younis, MSF Palestinian medical staff (which mainly specializes in burns) continues to work despite the hospital’s proximity to battle zones and bombings.
“They do plastic surgery there, because besides broken bones and other injuries, the airstrikes often cause burns,” says Burns. Until three weeks ago, Burns and other international workers from Doctors Without Borders were arriving to work at the hospital.
He can’t get one of the wounded patients his colleagues treated there out of his mind. “The house she lived in was hit in a bombardment,” he says. “Two of her relatives were on fire and she hugged them to extinguish the fire. The fire caught on her, too, and she arrived at the hospital suffering from fourth-degree burns. The pain is horrendous, all the skin is burned, and the fat, too.” To top it all, it’s currently extremely difficult to obtain medication and pain relievers in Gaza. “The staff assumed that her two relatives had died, but they were afraid to ask.”
Burns says the medical staff there does its work even under constant bombardment and shelling, with the sound of tanks always audible. The international staff used to come from the coast, he says – the only safe way to reach the hospital until the military ordered to clear the block of buildings behind the hospital, where the access route passes.
That’s why they stopped going there. More than 10,000 displaced people are sheltering at the hospital, he says, besides the wounded, staff, and ill patients. “So many people that you can barely get in and out of the building. They’re in every corner, between the patients and the beds.”
All the beds are taken, so when the wounded arrive, the staff treats them while they’re lying on the floor, the doctors kneeling in blood beside them, Burns says. MSF’s 14 Palestinian doctors and nurses, cut off from their families, were basically living inside the operating room to stay with the sick and wounded.
“Every doctor brings in mattresses and sleeps next to the OR,” he says. “Somebody prepares something for everyone to eat. Early in the morning, they clean the place and prepare for another day of surgeries. They’ve been doing this since the start of the war.” There’s always the risk that a shell will hit the hospital. “But the Palestinian doctors stay with their patients,” he stresses.
On December 18, a shell struck the hospital room of a 13-year-old girl who had lost a leg when her home was bombed. The girl, Dunya Abu Mohsin, was struck in the head and killed. That same morning, a shell fell in an inner courtyard where many displaced people have been crowded. In both cases, the shells did not explode, the hospital director told a reporter from Al Jazeera.
Until the end of December, the hospital kitchen was functioning and providing food for the medical staff, Burns says. However, the organization that donated the rice and bread couldn’t reach the hospital because of the airstrikes. “Now people have to manage on their own or coordinate with other organizations to bring them food.” What about food for the sick and wounded? “That’s a good question,” Burns replies.
With the same determination and dedication, medical staff, including Doctors Without Borders’, continued working at Al-Awda Hospital in Jabalya as fierce fighting occurred nearby and when the IDF called for hospitals in northern Gaza to evacuate patients, medical staff, and the displaced sheltering there. On November 21, three doctors were killed at the hospital, including two from Doctors Without Borders, Mahmoud Abu Njeila and Ahmad Al-Sahar, when a shell struck the third and fourth floors. Several more people were wounded, some seriously.
“Seeing doctors killed next to hospital beds is beyond tragic, and thus must stop now,” the organization said that day. It did not place the responsibility on any particular party, as it couldn’t determine with certainty where the shell came from. But Haaretz was told that the NGO’s staff believed the IDF was the source of the deadly shelling.
Three days before that, on November 18, a convoy of five vehicles clearly marked with the organization’s logo – including on their roofs –came under fire. The vehicles were transporting 137 employees of the organization and their families, including 65 children, who had left their homes several weeks earlier and found shelter in three buildings rented by MSF in Gaza – a guesthouse, office, and clinic.
They’d been unable to move for a week due to the fighting between Israeli troops and Hamas fighters near Al-Shifa Hospital. After the organization made several requests to the IDF to enable their safe evacuation, a date and time were set and conveyed to both the IDF and Hamas. The convoy came under fire anyway, and two relatives of Doctors Without Borders staff were killed, including one who also volunteered for the group.
After collecting evidence for several days, MSF concluded that the IDF was responsible for firing on its vehicles. It continues to wait for explanations for the attack, it said in a statement. The statement also references accounts it had collected about an IDF bulldozer and other heavy military machinery causing damage to its clinic in Gaza and destroying four of its vehicles and about a tank that crushed a minibus the organization had brought from southern Gaza a few days earlier to transport displaced people. All its vehicles and the clinic clearly bore the organization’s logo, the statement said.
On November 6, a lab technician for the organization, Mohamed Al Ahel, was killed while at home in the Shati refugee camp. A bombardment in the area caused the building to collapse. Several family members were killed along with him. In the announcement of his death, MSF wrote: “It is clear that no place in Gaza is safe from brutal and indiscriminate bombing from the Israeli army.”
Burns was also in Gaza in 2018 and 2019, when he worked for another aid organization. What’s different now compared to then, he says in a phone call, is that back then, a lot of people joked that they wanted to leave. “But today, all I hear is that people want to leave Gaza. No joking. One of my colleagues said to me: ‘The Israelis wrecked our past and our future, so why stay? Gaza is gone, there’s nothing to stay for.'”