I’ve been volunteering for various humanitarian missions for wars and natural disasters over the past thirty years. I have experience in combat trauma because I used to be in the US Army. So, when this started in October, I just felt I had the experience and the skills to make a difference. Doctors are some of the few people that are able to get into Gaza. I felt I had an obligation to try. I entered Gaza on May 1 and I left on May 21.

You have different types of injuries: blast injuries from bombs, which is a combination of shrapnel and multiple penetrating wounds and barotrauma, but also gunshot wounds, usually from high-velocity, high-powered rifles. Those are the primary injuries we saw. Almost every one of these has long-term effects. When people have limb injuries with open fractures, the bones — in order to heal — need soft tissue to cover it. Oftentimes, the bones are exposed and we need to move muscle or skin around to cover them. With the contamination we see in Gaza, they often need to be debrided — meaning, to clean the wounds and remove the dead tissue around it. That’s primarily what I was doing. I also took care of lots of burns. And injuries to the face: gunshot wounds, blast injuries, facial fractures.

This is what made this different from all other places I’ve been. War is horrible. People get wounded and killed. But it’s usually combatants. In Gaza, most of the people I took care of were children. Most of them under the age of fourteen. It went down to one or two years of age. I’d say, about 60 percent of the patients I treated were children.

I don’t think so. It was primarily children, women, families. But because of the density of the population, almost everywhere you hit, you’re going to hit a lot of children. And these devastating weapons, weapons that are supposed to bust bunkers in mountainous areas, are being used in dense neighborhoods. They’re being dropped on homes, and even tents. They destroy everything around them. They shred buildings, people, and children. This is what we were seeing the entire time we were there.

Everything that happens in Gaza is deliberate. When you drop a bomb on a tent in the middle of a refugee camp, that’s a deliberate act, knowing that you’re going to kill mostly civilians. I’ve seen gunshot wounds to the face in children. If those were accidents, it wouldn’t happen every day. The fact that this is happening every day shows that this is a deliberate decision to target civilians. Most of the people I saw couldn’t be confused for a combatant. You can’t confuse a two-year-old for a combatant. You can’t confuse a family with four children, grandparents, and aunts with combatants. And not every single male in Gaza between the ages of fifteen and sixty is a combatant.

In my three weeks at the European Hospital, I did not see a single weapon. Not one rifle. Not one pistol. Not one grenade launcher. This was a completely benign civilian hospital with no tunnels underneath it. I also visited Nasser Hospital and saw, again, a very standard hospital, completely destroyed, with holes on the outside from tank shells, blood on the walls and on the floors from what had happened when the Israelis were there. The excuse is always that these are hideouts for terrorists. There have been over fifty [medics] from the United States who have been there at different times in different places throughout the Gaza Strip. None of them witnessed anything like that.

It’s numbing. Look, I still sometimes wake up and think about things I saw twenty years ago from other wars. But nothing compares to what I have seen in Gaza. As doctors we tend to compartmentalize and just take care of the person in front of us. But that’s a temporary fix. These images do stick with you. And there isn’t a day that I’m not thinking about what I saw in Gaza. I’m in daily contact with Palestinian doctors on the ground right now that are telling me what’s happening. It’s not something you want to take out of your mind. But even if I wanted to, it wouldn’t be easy to do.

Rafah was invaded around May 6. When I first got to the European Hospital, there were people living on stairwells, in hallways, in and around the hospital. By the time I left, 90 percent of them were gone. There was still staff there, but people were leaving out of fear. They knew that our presence was a form of protection. Once we left, we weren’t going to be replaced. At that point, all the other hospitals had been raided. Doctors had been taken as prisoners, doctors were killed, nurses were killed, patients were killed. Many of the people there had experienced it firsthand. So, they left, based on their previous experiences.

Some went to Shuhada al-Aqsa Hospital further north, some went back to Nasser Hospital, which started functioning again at a limited capacity. Some of them are now in al-Mawasi living in tents. Many went with their extended families and many of the hospital staff stopped functioning as health care workers to take care of their families.

I worked with a Palestinian surgeon who was the acting plastic surgeon at this hospital since the beginning of the war. Now, he’s great at wound care because of all the experience he’s gotten over the past months. I also had a team of Palestinian medical students whose schools had been destroyed at the beginning of war. Many of them had nothing to do and wanted to become doctors. They all migrated there and rounded with us as volunteers. Plastic surgery is one of the largest services there, since there are so many patients that need wound care. And so, they would round and help in the operating room, acting as nurses and assistants. The Palestinians really hosted us and treated us like guests, the whole time.

They’ve been seeing these types of injuries every single day since October. As volunteers, we come with excitement. We come with the illusion of having available the resources we have at home. Unfortunately, that’s not the case in Gaza. The Palestinians know that. So yes, they’ve been worn down. Their emotional banks were exhausted. They know this person is likely to survive, that person is more likely to benefit from the very limited resources. By the time we left, we felt the same. We were making the same kinds of decisions and looking at patients in the same way.

Our team was probably the last team to enter Gaza with lots of supplies. We came in with 250 bags of antibiotics, anesthesia, medications, sutures, and instruments. We were able to bring all that in so we could function and operate. And we were using all of it while we were there. As we used them, the supplies dwindled. It’s simply not enough for an entire hospital. The teams of volunteers going in today are no longer allowed to carry supplies or medications. So they are basically operating with whatever is left.

They’ve been cut off. The only thing going in now is food, but not enough to supply the whole population. From the Egyptian side, almost no trucks with medications have gone in. Pallets with medical supplies have been sitting at the border for about three months and haven’t made it in. It’s important to note that this is leading to more deaths. Every time we hear of a strike and we hear a number of killed people, that’s the number killed right there. If ten people are killed and twenty-five are injured, many of those injured are going to die in a short period simply because the doctors don’t have the necessary resources.

They are practicing to some degree, because that’s what they have to do. You work with what you have. Things that are disposable here in the United States are getting washed and reused: disposable endotracheal tubes, tubes for ventilators, catheters. That happened while I was there, too. All of it is being reused because that’s all they have. Until we can resupply them, they’re just going to improvise and do their best.

We knew they didn’t have supplies. But we didn’t know the level. We went with supplies and didn’t even find soap. Those aren’t things we thought of: things to sterilize, soap, bedsheets, and gowns. These are so basic, they weren’t even on our radar. What we didn’t expect also is the sheer level of devastation. Most of the hospital [patients are] some form of child. And they’re not healing since there’s no nutrition. The food situation has gotten worse every week since October. When I was there, people lost thirty or forty pounds. I myself lost around ten pounds. Some of my colleagues lost even more. As surgeons, we’re tailors. We sew and hammer things together. But without nutrition, all the surgery in the world is not going to make a difference.

The thing that makes this so different from everything else is the fact that it’s not just hitting combatants. It is primarily hitting innocent people. This isn’t a natural disaster where it happens one day and now everybody’s recovering. This is a disaster that’s happening every single day that is primarily targeting civilians. And we’re allowing this to happen. We’re not really doing anything to stop it.

If we have a country that’s transgressing international laws, then we are going to put sanctions on that country. That’s the least we could do. To not continue to send them weapons, and to enforce an economic embargo. When I was stationed in Sarajevo during the Bosnian War about thirty years ago, we had the United Nations Protection Force there. We ensured that health care facilities, medical supplies, and food were delivered. We did something to protect civilians.

Ten months into this war, I would expect that we would do something to stop this. But rather than stopping it, we are encouraging it. We are still supplying the weapons and funding. This is ridiculous. How can we, as supposed leaders in the international community, stand up for the blatant transgressions against international norms and then expect our adversaries to take us seriously? We’re actually increasing our own insecurity by allowing this to happen.