A child needed a ventilator, then we found maggots in his throat

As I was operating on an eight-year-old child who was bleeding to death, a scrub nurse alerted me to the fact that there were no more swabs available.

The solution?

I was reduced to scooping out the blood with my hands. A wave of nausea hit me from the anxiety that the child would not survive.

Fortunately, she did – although many others did not.

This is just one of the patients that has stuck with me while volunteering with Medical Aid for Palestinians (MAP) and the International Rescue Committee last month at Nasser Hospital in Gaza.

One year on from October 7, the situation on the ground there – especially for health workers – is still critical. 

Across a 41-year-long career in medicine – starting as a consultant surgeon in 2002 – I worked as a professor of transplant surgery at a large teaching hospital in London but retired from the NHS in 2022.

I decided to go to Gaza because it had become clear that there was a desperate need for surgical help and I had the skill set to contribute. I knew volunteering there was going to be a different experience, but nothing had prepared me for what I found when I arrived.

From the moment we crossed into the territory on August 13 and a large Swedish man in an incongruous flowery shirt – leading the convoy of armoured UN Land Cruisers – exhorted us to ‘try not to get killed,’ life became a bizarre, disorienting experience of extremes.

Indeed, the same vehicles were fired on by the Israeli army a fortnight after we arrived. Gaza is one of the most dangerous places to work in the world, with more than 300 aid workers thought to be killed since the start of Israel’s military offensive a year ago.

In this time, more than 41,000 Palestinians have been reportedly killed – at least 11,000 of them children.

The journey across southern Gaza to where we were staying looked like what I’ve seen in grainy photographs of Hiroshima. All buildings, for many miles, were literally flattened into the dusty landscape – and people were conspicuously absent.

Having arrived at Nasser Hospital in Khan Younis, we found unimaginable, mediaeval chaos.

Wards were overflowing, with beds rammed against each other in rooms and corridors, and spilling onto the open balconies. Many were surrounded by filthy mattresses on the floor where relatives slept in order to help the nurses care for the sick.

Hygiene was non-existent. From what I experienced, no soap, shampoo or cleansing gel was allowed into Gaza by the Israeli military and medical supplies – which are also subject to import restrictions – were limited. At various points, we ran out of sterile gloves, gowns and drapes.

On several occasions, I inspected wound infections to find crawling maggots. One day, my MAP colleague in intensive care had to remove maggots from a child’s throat when he found them clogging their ventilator.

The hospital regularly shuddered from nearby Israeli military airstrikes, with the closest being in the street outside. Every day, we received one or two mass casualty incidents, which transformed the emergency department into a heaving maelstrom of dead bodies, blood, tissue and limbless screaming children.

Usually this would mean 10 to 15 dead, and 20 to 40 seriously injured. This has been the relentless situation medical workers have been facing for a year now.

The exhausted local staff humbled us with their dedication and hard work, since – apart from the conditions in the hospital – they also had to contend with living in ‘tents’. These are often just pieces of carpet tacked onto wooden posts, with no water or sanitation.

Often an evacuation order would come, meaning a family with young children and elderly relatives would have minutes to pack up, walk for miles and look for a small patch to set up again – so staff would regularly disappear.

There are no safe zones in Gaza. Most of the population of some two million is crammed into the green zone, which is about the size of Romford Town. Despite being designated as ‘safe’, bombs were dropped on this area routinely.

We could receive casualties at any time – day or night – and sometimes operated for over 24 hours. Sleep was difficult and there was a constant concern that the regular bombing close to the hospital would one day target us.

The images of injured children will never leave me.

One evening, I operated on seven-year-old Amer, who had been shot by one of the Israeli military drones that descended immediately after a bombing to pick off those who were running away. He had sustained injuries to his liver, spleen and bowel, and had part of his stomach protruding through his chest.

I was so glad to see him survive. But we saw patients like him every day, and many were not so lucky.

The majority of the cases we treated were women and children. Particularly disturbing were the children with a single injury – a bullet to the head – which was clear to me as the result of deliberate sniper fire.

Palestinians feel that they are undergoing a genocide, while UN human rights experts and the International Court of Justice have concluded Israel’s actions may plausibly amount for this to be the case. From what I have witnessed on the ground, it is difficult to argue with them.

I have worked in a number of conflict zones, but have never seen so much civilian death and destruction. This is undoubtedly qualitatively different from any other war.

What is clear is that – without a ceasefire – many, many more civilians will die.

Even if the bombing stops tomorrow, it will take years to reconstruct Gaza, both physically and as a society. My profound hope is that young Amer – and others like him – are given the opportunity of a decent, humane future.

Unlike myself and other aid workers, Palestinians can’t escape the horror.

When the convoy rolled back out on September 10 – after I spent almost a month on the ground in Gaza – with the Swede now in a more sober green shirt, I was left with an overwhelming sense of guilt that I could go back to an easy life.

All the while, millions of others went to bed hungry, wondering if they would be blown to pieces overnight.

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