“The patients. The families. They’re all in my head.”

Our Co-Founder David Nott recently travelled to Rafah, Gaza, to help treat the thousands suffering from war injuries, malnourishment, and everyday ailments that have progressed to life-threatening conditions because of delayed treatment. Here, David shares what he witnessed, what the urgent medical needs are on-the-ground, and how those he met are tattooed onto his mind.

After travelling from Cairo and getting closer to Gaza, it was quite a shocking experience. At the Rafah crossing, you could see miles worth of trucks in a queue trying to get in.

Driving through Gaza, it was like an enormous refugee camp with tents everywhere. Every single place that wasn’t occupied by somebody had a tent on it. Most of the tents were so packed against each other it was difficult for people to walk.

Thousands and thousands of people were in a small area. They had nowhere to go.

Treating those more likely to live

The hospital I was working in was called Al Najjar Hospital, the only semi-functioning hospital in Rafah. It was small, with a limited number of beds, but ended up housing thousands of people. Every corner was full. Patients were in the corridors, all over the wards, lying on the floor, five people where one might stand. There were people on the floor that were dying, some that had died – people crying out for help.

I had to step over people to get to patients. I had to make rapid decisions on whether or not they could be saved – decision-making techniques that we teach to those that attend our courses.

The hospital only had two operating theatres. There was no intensive care unit and no ventilators, so I had to decide which patients should be operated on with the best possible outcome. On ward rounds we reviewed those that had been treated, but many had infections because of limited sterile space or antibiotics.

18th century illnesses

Because thousands of people have been compressed into small spaces, and many haven’t sought medical care for their everyday conditions, the clinical needs in Gaza today are astonishing.

It’s not just war wounds that doctors face – ruptured appendices, hernias, ulcers, gangrene. General surgery has been delayed for months on end and people are dying or losing limbs as a result of problems that could have been resolved quickly.

This is the reality of trauma in war – some traumas that were not traumas to begin with become life-threatening – racking up death tolls even further.

Outside of war wounds, 21st century doctors are dealing with 18th century illnesses.

Children with chest infections were developing a condition called empyema – their infections had become so bad that their lungs were filling with pus. I’d never seen that before – it’s an 18th century condition that you would never see today.

Post-operative care felt impossible. Say you amputate somebody’s leg, there’s nowhere for them to go to recover safely. Tents aren’t sterile and it has been so cold, with the wind coming off the beach.

Calm amongst the chaos

Despite the chaos, Gazan doctors are truly outstanding. They were so warm and helpful. They were grateful that people were there to help, and together we did everything we possibly could.

This war zone is different to the others I’ve been in. The volume of people and the lack of basic medical or human resources made it incredibly challenging.

They urgently need field hospitals, more staff, a huge amount of medical resources. They need more doctors, nurses, rehabilitation services, physiotherapists. But not only that, they need a safe place for patients to go to recover after operations. Their medical aid needs are huge and doctors in the field need to be supported.

Seeing Gaza reminds me of the vital importance of our foundation’s work. Training doctors, operating on patients in war zones, bearing witness to doctors’ needs on the ground, I’m more driven than ever to help the charity grow so we can reach even more people in need.

The patients, the families, they’re all in my head. They will always stay in my head.