Children and babies were often among the injured and sick in Nasser Hospital in Gaza. Image: IRC
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Dr Nizam Mamode and Dr Ammar Darwish were in shock when they crossed the border from Israel into Palestine. It looked like an atomic bomb had landed. Rubble stretched for miles and the few people in sight were armed looters. It felt like a post-apocalyptic world.
They, along with a team of volunteer doctors, arrived in central Gaza, where two million people are crammed in a tiny area in makeshift “tents” – often just carpet or plastic draped over poles.
It is a year since war erupted in Gaza and the official Palestinian death toll exceeds 40,000, with thousands more buried under rubble or threatened by disease. But the numbers fail to capture the horror the doctors witnessed.
“We saw horrendous injuries,” Mamode recalls. “Many children with traumatic amputations of their limbs. Children who’d been shot in the head, clearly deliberately because there were no other injuries. Children who’d been targeted by drones.”
Dr Nizam Mamode carried out the first robotic transplant in the UK, and he appeared in Netflix’s The Crown. Image: IRC
Mamode, formerly professor of transplant surgery at Guy’s and St Thomas’ NHS Foundation Trust and Great Ormond Street Hospital, had volunteered in conflict zones before. But nothing prepared him for Gaza.
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“The devastation and the suffering were unimaginable,” Mamode says.
Darwish, a general and major trauma surgeon at Manchester University NHS Foundation Trust, has extensive medical humanitarian experience, having been on over 50 missions over the last 15 years to Syria, Iraq, Yemen, Libya and Ukraine.
“Gaza was worse,” he says. “The amount of destruction that you can see and the huge amount of displacement is shocking. This is the worst mission I’ve seen from every aspect.”
This was Darwish’s second deployment to Nasser Hospital – the first was in January – and conditions have only deteriorated.
Every day, at least one mass-casualty event brings between 20 and 40 seriously injured people, many of them women and children. Overcrowded wards, poor sanitation, lack of supplies and constant bombardment makes treating patients nearly impossible.
“We ran out of swabs at one point, and we were operating on a child,” Mamode says. “We had to scoop out the blood with our hands. We ran out of gowns, gloves, sterile drapes. The wards were overflowing. We had beds jammed in corridors on the balcony. We had people sleeping on filthy mattresses and blankets trying to look after their relatives to help the nurses.”
Patients faced injuries unlike anything the doctors had seen before – with drones used for targeted attacks. Image: IRC
The emergency department was chaos. There were “hundreds of people, blood everywhere, seriously injured people lying on the floor”. Beds were packed together, literally touching each other, spilling into corridors and out on the balconies – open to the dust, wind and rain.
“There’s no soap, shampoo, or hygiene products allowed into Gaza,” he adds. “Hygiene is very difficult, both within the hospital and outside, and as a result, infections are rife. We saw several wounds with live maggots, and we had flies landing in our operative field when we were operating.”
The war has seen Israel tighten a 17-year blockade into a full siege, preventing humanitarian aid from entering Gaza. Only 15% of hygiene items which were available in September 2023 are accessible now, according to aid organisations.
“We know polio has arrived. There will potentially be cholera and other infections,” Mamode says.
The doctors were not allowed to bring in medication except for their personal use. Mamode describes seeing “acres of aid lying on the tarmac” at the crossing between Israel and Palestine. Half of the required blood supply is unavailable in Gaza, and 65% of insulin needed is not there.
“We saw patients with diabetes in comas because they don’t have insulin,” Mamode says. “I amputated limbs from people because they had infections. We saw people with cancer who could have been treated, but there’s no chemotherapy. There’s no radiotherapy.”
The doctors tried everything they could to save lives, but they were limited in resources. Image: IRC
One young doctor contracted hepatitis – a preventable disease in hygienic conditions, for which he could have been vaccinated. He died in the intensive care ward where he worked.
Mamode says he often felt “helpless”. “We operated on a few people, and may have saved a few lives, but there’s a huge number of people suffering, who died, or were going to live lives with permanent disability.”
Due to the danger of travelling, the doctors remained at the hospital, sleeping in a room with 10 people adjacent to the intensive care ward. They heard monitors beeping and desperate noises from patients in pain.
Drones were a constant threat. “They’re like annoying wasps,” Mamode says. “You’re always aware they’re there. You’re worried the drone could see you and fire. In most other wars, there’s a sense that aid workers and journalists are not targets. In this war, that’s not been the case.”
Dr Ammar Darwish has previously worked in conflict zones including Ukraine and Syria. He believes Gaza was worse. Image: IRC
Since October 2023, more than 280 aid workers have been killed in Gaza. When Darwish was in Gaza in January, his safe house was bombed.
“I was awake,” Darwish recalls. “I heard the noise of the rocket when it came through, and the explosion and light behind me. All the doors and the glass broke. If that rocket was three or four metres closer, it would have hit the house, and most likely I wouldn’t be speaking to you today.”
Everyone survived – but trust in their safety was shattered. Human rights groups have urged governments to stop supplying arms to Israel, which may be used in violation of international law as violence escalates in Gaza and recently Lebanon.
The UK recently suspended 30 out of 350 arms export licences to Israel, affecting parts for fighter jets, helicopters and drones.
Campaigners say the suspension remains “too limited” and are calling for a ceasefire and for humanitarian aid to be allowed into Gaza.
“There’s no escape for people,” Mamode says. “They can’t leave Gaza. Most of the casualties that we received were from the so-called green zone. I won’t call it a safe zone, because it’s absolutely not.”
Big Issue has spoken to UK families desperately trying to get their families out of Gaza, but there are no safe routes. Calls for a Ukraine-style visa scheme to reunite Palestinians were dismissed by the Home Office. The only way out is through private companies in Egypt, at a cost out of reach for most Palestinians.
Conditions in the hospital were gruelling and they never left. They slept in a room that backed onto intensive care. Image: IRC
Mamode and Darwish have returned to the UK after their month-long mission but are finding it difficult to readjust.
“You feel very guilty when you leave,” Mamode says. “I think all of our team wants to go back. We’ve been working with some amazing people. They can’t leave and they’ve been enduring this for a year, and we were able to leave and come back to the UK to live a normal life.”
Mamode often thinks about his colleagues and a junior doctor he worked with closely. The man sees his family only once a week – his wife, two young children and elderly father live in one of the thousands of tents, unable to leave despite losing their home and fearing for their lives.
The doctor works seven days and six nights a week. He says goodbye knowing that he might not come back, or that he might not be able to find his family again. Still, his father tells him: “You need to go back to the hospital and help the people there. They need you.”
“It put tears in our eyes,” Darwish says, reflecting on leaving the Palestinian doctors behind. “I’m leaving what I call hell on Earth, and I’m going back to my family who are safe. I’m going back to my job. I’m going back to my country where I have a warm house. I have food, clean water. Leaving them behind, knowing that I might not see them again, breaks my heart.”
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