When Texas neurologist Hamid Kadiwala told his parents he was heading to Gaza to volunteer at a hospital there, they begged him to reconsider.
“Why would you take that risk?” they asked. What about his Fort Worth medical practice? His wife? His four children?
But Kadiwala, 42, had been deeply shaken by images from Gaza of mass death and destruction and felt a responsibility to act. Israel’s siege on the small, densely populated Gaza Strip was “a history-shaking event,” Kadiwala said. “I want my kids to be able to say that their father was one of those who tried to help.”
Kadiwala is one of dozens of American doctors and nurses who have worked in the Gaza Strip since 2023, when Israel began bombing the enclave in retaliation for the deadly Hamas attacks of Oct. 7.
The volunteers — men and women of all ages, agnostics as well as Muslims, Christians and Jews — have labored under the constant threat of violence, amid raging disease and with little access to food and medicine they need to save lives.
Many are hopeful that the new ceasefire between Israel and Hamas that took effect Friday will halt the violence. But even with new aid rolling in, the humanitarian crisis in Gaza remains daunting.
With foreign journalists largely barred from Gaza and more than 200 Palestinian media workers slain by Israeli bombs and bullets, on-the-ground testimony from doctors and nurses has been critical to helping the world understand the horrors unfolding.
But bearing witness comes at a steep personal cost.
As Kadiwala drove into the enclave in a United Nations convoy late last year, he saw an endless expanse of gray rubble. Emaciated young men swarmed his vehicle. The sky buzzed with drones. Bombs sounded like rolling thunder.
Kadiwala compared the landscape with dystopian films such as “Mad Max.” “It’s so hard to understand because our brains have never seen something like that,” he said.
He knew that worse was yet to come.
“You have to get numb,” he told himself as he prepared to enter Nasser Hospital in Khan Yunis, where he would be living and working for more than a month. “These patients are here for help, not to see me cry.”
Death in Gaza
The explosions began each morning shortly before the call to prayer.
“Within 20 minutes, there would be 150 people sprawled wall-to-wall with serious injuries,” said Mark Perlmutter, an orthopedic surgeon from North Carolina who has been to Gaza twice, and who was working at Nasser in March in the violent days after a ceasefire broke.
Perlmutter, 70, had volunteered on more than 40 humanitarian missions: in Haiti after its devastating earthquake, in New Orleans after Hurricane Katrina and in New York after the 9/11 attacks on the World Trade Center.
Nothing prepared him for Gaza.
Hospitals stank of sewage and death. Doctors operated without antibiotics or soap. Never before had he seen so many children among the casualties. The hospital filled with shell-shocked kids who had been wrenched from collapsed buildings and others with bullet wounds in their chests and heads.
“I would step over babies that were dying,” he said. “I would see their blood expanding on the floor, knowing that I had no chance of saving them.”
In one haunting experience, an injured boy lying on the ground reached for Perlmutter’s leg, too weak to talk. Perlmutter knew it was too late for the boy, but that other patients still had a shot at survival.
“I had to pull my pant leg away to get to one I could save,” he said.
Perlmutter is Jewish and until visiting Gaza was a supporter of Israel. Around his neck he wears as a pendant a mezuzah, which contains a small scroll with verses from the Torah. It was a gift from his late father, a doctor who survived the Holocaust.
But working in Gaza changed him.
After treating so many kids with gunshot wounds, he became convinced that Israelis were deliberately targeting children, which the Israeli military denies.
As he toiled, he and another doctor, California surgeon Feroze Sidhwa, began taking photos of the carnage. Together they would go on to publish essays in U.S. media outlets detailing what they had seen and to send letters to American leaders begging for an arms embargo. Sidhwa would conduct a poll of dozens of American doctors, nurses and medics who said they, too, had treated preteen children who had been shot in the head.
Activism was a new calling for Perlmutter. He knew it might cost him relationships with loved ones who supported Israel and possibly even patients at his medical practice back in North Carolina. He knew it was straining his relationship with his wife. But he plowed ahead.
“It’s hard to see so many kids die in front of you and not make that your life.”
Hospitals under siege
Andee Vaughan, a 43-year-old trauma nurse, has spent much of her life in ambulances, emergency rooms and on backcountry search-and-rescue trips in her home state of Washington. She spent months providing medical care on the front lines of the war in Ukraine.
She prides herself on maintaining her cool, even under trying circumstances. But while volunteering at Al-Quds Hospital in Gaza City, she often felt tears welling up.
It wasn’t the mayhem of mass casualty events that shook her, nor the sound of shallow breaths as a patient who had been shot in the skull slipped toward death.
It was the seemingly countless victims who under normal circumstances could have been saved.
Like the boy she watched suffocate because the hospital didn’t have enough ventilators. Or patients who perished from treatable infections for lack of antibiotics and proper dressings for wounds.
“I am haunted by the patients on my watch who probably shouldn’t have died,” Vaughan said.
Virtually every person she encountered suffered from diarrhea, skin infections, lung problems and chronic hunger, she said. That included exhausted Palestinian doctors and nurses, many of whom had lost family members, been displaced from their homes and were living in crowded tent cities where hundreds of people shared a single toilet. Many Palestinian medical staffers have been working without pay.
“You have a whole system in survival mode,” said Vaughan, who contracted giardia shortly after arriving in Gaza and who ate just once a day because there was so little food.
Vaughan spent three months in Gaza and volunteered to stay longer. Then her hospital came under attack.
As Israeli forces advanced on Gaza City to confront what they described as the last major Hamas stronghold in the strip, Al-Quds was sprayed by gunfire and rocked by bombs. Most of its windows were blown out. A tank missile hit an oxygen room, destroying everything inside.
Vaughan filmed videos that showed Israeli quadcopters — drones equipped with guns — hitting targets around the hospital.
“They are systematically destroying all of Gaza,” she said. “They’re shooting everything, even the donkeys.”
Just a third of Gaza’s 176 hospitals and clinics are functional, and nearly 1,700 healthcare workers have been killed since the war began, according to the World Health Organization.
It is not lost on Vaughan that most of the weapons used in those attacks come from the United States, which has provided Israel $21.7 billion in military assistance since the Oct. 7, 2023, Hamas-led attack, according to a study by the Costs of War project at Brown University.
U.S. involvement in the war is what prompted Vaughan to volunteer in Gaza in the first place. “I was there in some ways to make amends for the damage that we have done,” she said.
Vaughan was evacuated from Gaza last month, bidding goodbye to colleagues and patients who were so malnourished their bones jutted from their skin like tent poles.
She was ferried to Jordan, where on her first morning since leaving Gaza she went down to breakfast, saw a buffet overflowing with food, and began to sob.
Coming home
After three tours in Gaza, Dallas emergency room doctor Bilal Piracha now works with a kaffiyeh draped over his scrubs.
The black-and-white scarf, a symbol of Palestinian liberation, often sparks comments from patients, some of them disapproving. Piracha, 45, welcomes the opportunity to talk about his experience.
“This is what I have seen with my own eyes,” he tells them. “The destruction of hospitals, the destruction of nearly every building, the killing of men, women and children.”
Like many other U.S. doctors and nurses who have spent time in Gaza, Piracha is racked with survivor’s guilt, unable to forget the patients he couldn’t help, the mass graves he saw filled with bodies, the hunger in the eyes of the local colleagues he left behind.
“Life has lost its meaning,” he said. “Things that once felt important no longer do.”
He now spends most of his free time speaking out against the siege, traveling throughout the U.S. to meet with members of Congress and making frequent appearances on TV and podcasts. He has marched in antiwar protests and dropped massive banners from Texas highways that say: Let Gaza live.
He is in frequent touch with doctors in Gaza, who are hopeful that the new ceasefire will put a stop to the violence, but say massive amounts of medical supplies and other humanitarian aid are needed immediately.
Piracha doesn’t know what to tell them.
“We can give them words of hope and prayers, but that is it,” he said.
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