Dr Mohammed Harara, 28, had only just started work as a GP when he was sent to the front lines of a war zone, forced to become a jack of all trades.
In the eight months since Israel launched its offensive on Gaza, Harara has seen more than he expected.
Like the maggot-infested wounds of the mutilated men he had to watch helplessly.
Lacking medicine and even basic hygiene equipment, Harara and his colleagues are unable to clean – or keep clean – the festering wounds.
Also complicating their struggles are the severely compromised physical conditions of patients, which take time to heal and can make such an infestation fatal.
“Slowly, these unsanitary conditions caused sepsis in the body and people died,” he told Tel Aviv Tribune.
The displaced, the injured, the fragile
Experts say rising rates of malnutrition are compromising the health of a people battered by Israel’s war, preventing them from fully recovering.
British vascular surgeon Mahim Qureshi saw that the Palestinians she treated during her two weeks volunteering in Gaza were severely malnourished.
As she and her colleagues from the British charity Medical Aid for Palestinians entered the besieged territory from Egypt, via the Rafah crossing, Qureshi remembers a welcoming atmosphere.
An “I love Gaza” sign greeted the team and the April weather was “perfect,” she says.
“I remember looking at that (sign) and realizing how privileged I was to be able to come to Gaza,” Qureshi told Tel Aviv Tribune.
But as they moved across the crossing, the devastation of the Israeli assault was everywhere, she said.
On his way to Deir el-Balah in central Gaza, the surgeon saw thousands and thousands of displaced Palestinians, many of whom were very frail and thin.
Once they arrived at the Al-Aqsa Martyrs Hospital, Qureshi saw hundreds of other displaced Palestinians, fragile and injured, crammed into every available space – in the reception area, on every floor, in the cages of stairs.
She was particularly pained to see children whose clothes were hanging off their small waists, as opposed to a healthy child who was gradually outgrowing their clothes, she said.
Over the next few days, she will see dozens of patients whose health has worsened due to starvation.
“People who would have had very treatable or curable illnesses several months ago are presenting today with very advanced illness,” Qureshi said.
For these individuals, their immunity and ability to heal was reduced, she added.
“The ability of cells to divide in the absence of vital nutrients from fresh food – and they haven’t had such fresh food for so long – (makes it) extremely difficult for the mind and body to divide. recover and regenerate,” Qureshi said.
Before the war, Palestinians in Gaza already suffered from micronutrient deficiencies, largely due to the Israeli blockade, according to Amber Alayyan.
But since October 7, rates of acute malnutrition have been increasing rapidly, said the malnutrition expert, pediatrician and deputy director of Médecins Sans Frontières (MSF) in Palestine.
Micronutrient deficiency is the term used to describe a lack of essential vitamins and minerals that our bodies need to function. But acute malnutrition is a broader problem, leading to diminished fat and muscle stores, Alayyan said.
“When you start worrying about a population that doesn’t have access to food, that’s when you start screening for malnutrition,” she told Tel Aviv Tribune.
But the war made even control impossible. Due to the destruction of hospitals and medical laboratories, doctors from MSF and other humanitarian organizations are unable to carry out blood tests to confirm malnutrition among Palestinians in Gaza as they normally would, said Alayyan.
Instead, they make diagnoses based on clinical symptoms, she said.
Symptoms include fatigue, injury-related complications including the development of chronic illnesses, pregnancy complications and poor healing of wounds and burns, the doctor said.
The inability to heal wounds is also compounded by poor hygiene and infection control, Alayyan said, conditions that his team and doctors like Harara and Qureshi have seen firsthand in Gaza.
“You’re more at risk of getting infections when your body isn’t well-nourished…tissues need to be healthy and well-nourished to be able to close over a wound,” she explained.
Alayyan and Qureshi compared a body suffering from malnutrition to a body suffering from anorexia nervosa, clarifying that the latter is a condition with a significant psychological component.
Yet even though malnutrition begins with physical deterioration, Harara has witnessed the devastating effects of malnutrition on the psyches of those he treats.
“The mental and emotional state of realizing what is happening to you is very exhausting,” he said, explaining that the body starts to feed on itself and slowly stops.
“No one will understand the extent of this damage if he did not survive.”
Improvisation in wartime
Alayyan said that while malnutrition is a common and unfortunate component of war, with food often used as a weapon in conflicts, its presence is particularly stark in Gaza.
Sudan experiences higher rates of malnutrition than Gaza due to the ongoing war there, but the rate at which malnutrition has increased in the besieged enclave over the past seven months is alarming, she said.
Access to those in need is also particularly difficult in Gaza, compared to other places where malnutrition is present, such as the Central African Republic or Nigeria, Alayyan said.
“When your teams are afraid of being attacked, bombed, shot themselves… it makes it very difficult for them to move around among the population,” she explained.
“That means you have very small sample sizes, because the only samples of people you get are those who come to your health clinic. You therefore cannot assess the state of malnutrition of the population because you do not see the entire population. We cannot, for example, reach the north – no one can access it safely,” she added.
Despite these obstacles and the inability to develop personalized treatment plans, MSF and other organizations are still trying to combat malnutrition in the population they have access to through nutritional supplements.
Qureshi also learned to adjust his practice due to war conditions.
At Al-Aqsa, she operated in an old maternity ward without “the basic equipment present in vascular surgery rooms” for decades, she explained.
Rooms lacked lighting and water, the ability to maintain surgical sterility was limited, and operating drapes had to be made from hospital gowns.
“We had to improvise, we had to innovate and we had to do the best we could with what we had,” Qureshi said.
Harara, who has been working day after day since October 7, knows full well that many of his dying patients could have been saved if supplies had been available.
The aspiring plastic surgeon, who has now treated patients suffering from all types of illnesses, wishes he had a superpower to save them all.
“I have had the honor of serving my people, but at the same time I am exhausted. I have been living in hospitals for seven months. There’s only so much a person can handle,” he said.
“I wish the world would be able to stop this from happening before we become history lessons.” »
