Hospital in Gaza City Engulfed by Suffering
Facility Short of Staff, Supplies for Wave of Injured

By Sudarsan Raghavan and Islam Abdel Kareem
Washington Post Foreign Service
Wednesday, December 31, 2008

JERUSALEM, Dec. 30 -- Rawiya Ayad lay in a bed on the ground floor of Gaza City's Shifa Hospital on Tuesday, connected to a respirator. A bandage covered her head, and dried blood scarred her face. Shrapnel from an Israeli airstrike was embedded in her brain, poisoning her blood. She was in a coma.

The hospital had no antibiotics to prevent her slow death. There was a shortage of electricity, too. So if the generator malfunctioned, Ayad's respirator would shut off and she could be dead within two hours. There were no skilled neurosurgeons. The eight-hour drive to get treatment in Egypt could kill her. Because of the cordon around the Gaza Strip, it was unclear whether she could make it to medical care in Israel.

"I have a feeling there's no way I can help her," said Fawzi Nabulsia, 57, director of the intensive care unit.

Shifa Hospital has once again become the ground zero of both Palestinian suffering and hope. The doctors there are accustomed to the violence in the region, having provided treatment through two intifadas, or uprisings against Israel. But nothing had prepared them for the chaos that began Saturday when Israel launched its air offensive.

"I saw the first intifada and second intifada, but what I saw this time I have never seen in my life," Nabulsia said. "What we suffered in Shifa, entire countries could not bear. All the victims of Gaza, it seemed, came to this hospital."

By Tuesday, the Palestinian death toll was at least 370. Hamas fighters had killed four Israelis in retaliatory rocket attacks into southern Israel since Saturday. At least 64 Palestinian civilians had been killed, according to the United Nations. On Tuesday evening, Shifa Hospital officials said they had treated 73 women and 150 children for injuries during the preceding 24 hours. Nine women and 22 children had died, said Hassan Khalaf, a doctor and senior official at the hospital.

For the past four days, humanitarian groups have been sounding the alarm about growing shortages of medicine, food and other basic necessities in Gaza. On Tuesday, Israel began to allow some shipments of humanitarian aid into the densely populated area of 1.5 million people. Some of the medicines reached Shifa, but doctors said they required much more assistance.

"We are in a very dire situation," Khalaf said.

Ten minutes after Israel attacked Saturday morning, scores of patients began to flood into Shifa. Only three doctors were on duty, recalled Ayman al-Sahabani: "We were not prepared for a day like this."

Within hours, the scores became hundreds. More doctors arrived to help. But still the surgeons and operating rooms were insufficient.

"Many people died while they were waiting to enter the operating rooms. Some died in the lobby of the hospital waiting to enter the reception area," said Hussein Ashor, the hospital's director. "There were not enough beds, so we pulled out the curtains and lay them on the ground, and we put patients on the curtains. The floor of the reception was covered with blood."

Some doctors performed operations in the hospital corridors, forced to use only local anesthesia and unsterilized equipment, recalled Hamid Rashid, an orthopedic surgeon.

"It was like a natural disaster," he said. "The injured were increasing by the second, and most of them were in need of surgery. I was looking at the faces of patients. I feared I would find among them one of my sons or relatives."

Sahabani said he ran through the hospital Saturday searching for his two injured brothers. "I even went to the morgue, where bodies were piled up on the floor. I couldn't differentiate between faces. All were covered with blood."

On Tuesday, relatives of patients sat inside the hospital. Now and then, some would rush to the windows when they heard an airstrike. During a two-hour visit to the hospital, a Washington Post correspondent heard eight missiles land across Gaza City. Doctors walked around with radios in their hands listening to the news. It was their early-warning system to prepare for another wave of wounded. One patient died Monday and another Tuesday because of a lack of medicines, doctors said.

On Tuesday, the hospital had a shortage of 150 kinds of medicines and lacked 230 types of medical supplies, hospital officials said. They included basic items such as gloves and scissors, as well as devices to sterilize equipment and nitrogen for anesthesia. There was also a shortage of specialists.

On Sunday, doctors said, men believed to be Hamas fighters grabbed a patient, accusing him of being an Israeli collaborator. The patient had been inside a prison that was hit by a missile. The gunmen shot him dead. "They took revenge," Khalaf said.

Often, the most serious cases were being taken to Israel. On Tuesday, 6-year-old Ahmed Hawez was scheduled to cross the border, said Nabulsia, the intensive care director. The boy had Down syndrome and was at home when a missile struck nearby. His father and some of his brothers were killed. Shrapnel tore into Ahmed's brain.

"No one comes to visit him except his distant relatives," Nabulsia said. "He will receive better medical treatment in Israel. Perhaps a neurosurgeon can save him."

Nabulsia said he didn't mind asking Israel for help. "I studied in an Israeli hospital. I trust my colleagues in Israel. I believe medicine is an issue of humanity. It doesn't have boundaries."

Nabulsia had more immediate concerns: He had one month of supplies left in his intensive care unit. Worse, there are shortages of fuel across Gaza. And the hospital had only a few days of fuel left for the generator, he said.

And he worried about Ayad, attached to the respirator and without antibiotics. "What will happen?" Nabulsia asked. "Eventually she and others who are on respirators will die."

Kareem reported from Gaza City.

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