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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.
 
"It was important for Médecins Sans Frontières expatriates to have a presence during the war, to provide care and witness what was happening. It was important for our Palestinian staff, too. Given the insecurity and danger, it would have been difficult to undertake more program activities. After the ceasefire, I didn’t know what to expect when I returned to Gaza. I saw the destruction – burned buildings, mountains of rubble, piles of sheet metal, rebar poking out through the reinforced concrete. The team was at the end of its rope. They had huge circles under their eyes, they were pale, their cheeks were hollow. They showed stress and fear that the conflict would resume, fear for the future. They got involved in setting up tents and providing emergency aid. That helped them pick themselves up and find a new rhythm.  

A response that met the needs

The two post-operative care clinics reopened immediately. When activities first resumed, we had lots of multiple injuries, fractures and severe wounds, along with people who had burns over large portions of their body and amputees, too. Sometimes, it took more than an hour to dress a single patient’s wounds. People didn’t speak. They were closed up inside themselves. We decided to increase the number of treatment staff, open a third post-operative treatment clinic in the north, an area hard-hit during the war, increase the number of mobile clinics from three to seven for severely-disabled patients living on upper floors or in still-sensitive areas, and pay for other patients’ trips from home to the clinic. We were operating on full steam. Médecins Sans Frontières adapted its post-war response to the needs.

We offer outpatient care, including wound dressing, medical follow-up, physical therapy (for an average of four months) and surgical consultations (orthopedic and plastic). Our teams are still monitoring 470 severely-wounded patients. Repeat surgeries will be necessary, primarily for external fixators and post-operative infections. We are offering group exercise sessions to amputees who are waiting for a prosthetic so that they can continue their recovery at home. This helps prevent complications like muscle loss and joint problems. All the medical equipment and supplies are pre-positioned in the event of a new emergency, available to the hospital staff whom we trained. The health system functions well here. Our added value is dealing with the gaps.

"The population is still held hostage"

When you talk with people, it's hard to be optimistic and it's difficult to believe that peace will come. The population is still held hostage, trapped within the borders. It’s impossible to leave Gaza, study abroad, obtain or share medical knowledge elsewhere, visit your family – even in the West Bank – or go on vacation. Those who manage to get out via Egypt can’t be sure that they will be able to come back.

There is no hope for the future. The Palestinian team working with Médecins Sans Frontières is young. They dream of earning degrees and seeing the world – and they can’t. The blockade prevents essential goods – like construction supplies and fuel – from entering. Humanitarian aid, medical supplies and international workers are also subject to the uncertainties of administrative authorisations. That can be very problematic as, for example, in the case of surgeons who are available only for a short period of time and who are held up from entering Gaza, or in the case of the last pharmaceutical order, which took two months to enter, resulting in shortages of certain medications.

"I saw him two weeks ago. Je was up and about."

Many of our patients are mourning the death of family and friends, killed during the war, and/or seriously wounded. One had to have both legs amputated after an F-16 bombed his courtyard. When he regained consciousness, he was awash in his own blood and seven members of his family had been killed. A 3 year-old girl was seriously burned and disfigured. Médecins Sans Frontières operated on her twice, but she will always bear those scars and the disfigurement will isolate her. We can't restore her face, her future, her life. Another man, in his 20s, was admitted in the mobile clinics. The first time I saw him, he was very thin. He was an invalid and malnourished. His legs were broken and he’d also been wounded in the abdomen. He didn't speak. He was completely introverted and his eyes were distant. That was in February. I saw him two weeks ago and he was up and about.

We help to repair these broken bodies, but we need to take broken psyches into account, too. Six months later, Gazans are smiling, joking, laughing, celebrating birthdays and marriages -- but they still think about it. They are still very marked by the events and they will never forget. Several patients have had their spirit broken. Their emotions overtake them and they can become very aggressive. They are referred to psychologists, but sometimes they refuse that help. Unfortunately, we then can't do anything else for them.

My mission is almost over and when I look back, I have to say that what goes on here is remarkable. I am proud of working with Médecins Sans Frontières, proud of what our teams manage to do and proud of the quality of care we offer."

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