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The Israeli military operation, "Cast Lead," was launched in the Gaza Strip on December 27, 2008.  Eight months later, what are its impacts on the civilians there? Conversations held in July 2009 with patients and Médecins Sans Frontières staff, both international and Palestinian, provide insights.
 
"When the war began, the project coordinator called me right away to tell me to get to the hospital. We stopped at the Médecins Sans Frontières pharmacy for items to assemble emergency kits, including dressings, materials to treat burns and drugs. We established and maintained hourly contact with certain hospitals and made donations based on needs. Ambulances picked up the supplies, even as bombing was underway. We couldn't get to the Shifa Hospital, which was close to the office. Wounded people were streaming in. Many people had died, so the morgues were full and bodies had been laid out in other rooms. There were 35 patients waiting for the 20 beds in the intensive care unit. The emergency rooms were overflowing too. The wounded were stabilised there before being sent to surgery. There were three operations underway simultaneously in the operating rooms. Given the emergency, many amputations were performed – 35 alone on the first day of the war. There was not enough staff. Those who had managed to get to the hospital did their best. They were exhausted.

Adapting regular programs to the emergency

We quickly decided to open the post-operative treatment clinic in Gaza with Médecins Sans Frontières staff living nearby so that we could treat patients who had been released from the hospitals too soon. Our other facilities – the post-operative centre in Khan Yunis and our paediatric clinic in Beit Lahia – could not be opened because of the security situation. When the land incursion began, we went to the United Nations Relief and Works Agency schools to assess the displaced persons' needs. There were doctors in the group so we provided them with supplies and medications so that they could treat people in the overflowing reception centres. There were not enough latrines, which raised serious hygiene problems. We distributed drinking water. People were panicked and depressed. The children were so frightened that they waited for the ceasefire to go to the bathroom.

"Other needs will emerge"

Médecins Sans Frontières must continue to do what it has always done: address medical shortages. Post-operative care will slow, but other needs – specifically, mental health – will emerge. The war's psychological impacts are considerable. Before January, Médecins Sans Frontières was the only NGO to offer mental health care to victims of violence. Since then, there has been an influx of specialised actors into Gaza, but few have the same treatment approach as we do and it is very difficult to coordinate what everyone is doing.

Hundreds of people have had a limb amputated, here and in other countries, during and after the war following complications. But it would be difficult for Médecins Sans Frontières to get involved in manufacturing prostheses. We'd need a structure, human resources and specialised equipment. Our 60 patients who are amputees are on the waiting list of the only local organisation responsible for this issue.

For me, nothing has changed in Gaza. It's as hard as it ever was. We will need years to recover. Everyone here lost someone during that war."

• Michele Beck
• Franck Joncret
• Elina Pelekanou
• Dr. Akram Nafie
• Dr. Abu Abed
• Patient Stories
• Gaza strip update