The Israel-Hamas war has caused enormous damage to Gaza’s hospitals and health facilities. Attacks on hospitals are generally considered to be against international humanitarian law. Israel has contended that Gaza’s Al-Shifa Hospital and Indonesian Hospital—both targeted by Israeli forces—were being used as Hamas hideouts. Hamas and the hospitals’ staff have denied these claims.
Northan Hurtado, head of the Doctors Without Borders/Médecins Sans Frontières (MSF) medical unit based in New York City, spoke with Scientific American about how war and attacks on hospitals threaten care for the patients, staff and civilians who shelter there and what is needed to provide lasting relief in Gaza.
[An edited transcript of the interview follows.]
What are some of the key functions that hospitals and health care workers perform that are threatened in war zones?
It’s never exactly the same. But I will say that there are two main things. The first one is safety and security for our staff and the patients that we treat. The second one is having the resources to treat them. These could be human resources or they could be the material, medicine or medical devices—or both. It’s not only medicines and medical devices; it’s water, electricity, refrigeration, disposal of waste. Hospitals are very complex structures, and depending on the size of the hospital, it can be fairly challenging to manage.
The first one is the key one: How can we be sure that we can safely treat people in that place? And the second one will depend on the situation. If you go to Gaza today, probably the southern part of Gaza, you will still have some structures; if you have the right supply and the right human resources, probably you can do a lot of things. That is not the case in places such as South Sudan, where the hospitals have been badly hit or they’ve been neglected for years in areas quite isolated from the rest of the country, and then you have really crumbling structures. That is more complex.
What are the most critical resources a hospital needs, and how does war pose a threat to them?
The two things that are quite important, for sure, are water and power. One of the few phrases that probably every medical student on the planet knows in Latin is “Primum non nocere”—that means, “First, do no harm.” So one of the things we want to do is always provide a safe environment. When I say safe, it’s safe from the infection prevention and control point of view; the people who are going to the hospital sick are not getting sicker [by being at the hospital]. Water plays an important role in that because you have to use clean water for washing wounds or for the restrooms.
Then, for sure, electricity is important. [With MSF] I work in hospitals where we have only about four or five hours of electricity per day. We have fridges or freezers that can work with only a few hours of electricity per day. We have oxygen concentrators [devices that take oxygen from the air and concentrate it to help people breathe], which needs a constant flux of energy. The cold chain [a supply chain that requires refrigeration] has a large impact because it involves the blood bank, the vaccines and some of the drugs we use. We have to be really careful not to lose all these things because in those areas in general the supply is quite challenging, and it takes several weeks to get the material again if you have, for example, a rupture in the cold chain.
At the end of the day you need to get a certain amount of electricity per day. We have three options. One is the supply that comes from the country. You can imagine that in war the supply’s going to be interrupted or nonexistent. Second, we bring our own generators. That sounds good, but you have to think of all the logistics that go behind supplying fuel for the generators. And fuel in war zones is important because you need the fuel to move your car or tanks or use your own generator. And the third option, which is more difficult to do because you have to have infrastructure, is solar energy.
The problem today in Gaza is the supply of fuel. You can bring the generators, but you have to be sure as well that you can supply the energy.
Several babies at Gaza’s Al-Shifa hospital died because the incubators that were keeping them alive were powered by generators that ran out of fuel. Is there anything that can be done in such situations as a stopgap?
Most of the babies in Al-Shifa were finally transported to the south. Incubators sometimes have batteries and things like that. We tried to get a supply of incubators that can work independent of energy for a while until they could get supply again.
There are some measures [that can be used in place of incubators], such as kangaroo mother care, in which you put the baby on the skin of the mom. You can use the incubator for a while when there is some energy there, but then you can use the mother as a natural incubator that keeps the baby warm. But the baby must be healthy enough that you can take it out of the incubator.
There have also been reports of people in Gaza having surgery without anesthesia. Have those been confirmed?
Yes. At one moment, the supply of analgesics—narcotics—was quite short. You know, we’re keeping [doses] for extreme cases. You have to prioritize the use. For example, to do an operation on a child, you have to anesthetize the child. So some people were having wounds dressed without anesthetic. It was quite bad.
What’s the situation in Gaza right now?
MSF staff has been working in some of the health structures that are still functional in the south of Gaza. I won’t say that it’s good news, but a lot of people were pushed to the south, including our medical staff. That is good because you have more colleagues to work with. What is still challenging is the supply of medicine and material, even in the south of Gaza. Today with the few materials we have it’s not a perfect situation; we’re still trying to do the best we can. What we worry about most is the postcare of all these people.
What are some of the long-term health impacts that you worry about?
We work a lot in mental health [in Gaza]. In fact, we used to have psychiatrists working there because mental health is a big issue related to the conflict. It’s not new; it’s something that has been going on for a while. But the scale of today—that is the question mark. The sheer scale of the movement of the population, the people who are wounded today—the consequences of that are going to be enormous, that is for sure.
How can we ensure people in Gaza and other conflict zones can get the medical and social support they need?
We need a real cease-fire, not a pause—first, to allow us to ensure safety, and second, to allow the supply of material, medicine and drugs. Those are the two major things we are asking for: a cease-fire and the ability for us to do our work.