Gaza: Medical care under fire

Avril Benoît:

Welcome, and thanks for joining us for this conversation today. I’m Avril Benoit with Doctors Without Borders, joining you today from Berlin. Some of you might know us by our French name, Médecins Sans Frontières, or MSF. That’s what you’ll hear us saying today – MSF. We’ll spend most of our time focused on the humanitarian emergency in Gaza. The surge in conflict in Lebanon and across the region has somewhat overshadowed Gaza in recent weeks.

MSF has a dozen mobile medical teams active in different areas of Lebanon. They're providing psychological first aid, general medical consultations, and mental health support. They're also donating essentials like mattresses, hygiene kits, hot meals, clean water. And we're now very much in emergency response mode. While these conflicts overlap, we will spend our time today reflecting on the human toll of the war in Gaza. Just over a year ago, on October 7th, we were shocked when Hamas militants launched an unprecedented attack inside Israel, killing 1,200 people, taking 251 hostages. The Israeli military response also shocks the conscience. More than 42,000 Palestinians have been killed in Gaza, and that's likely an underestimation. 96,000 have been injured, nearly 2 million displaced, many of them repeatedly fleeing from place to place looking for safety. But these are not just numbers. These are human beings whose lives have been shattered. For Doctors Without Borders, our job is to respond to the medical needs of people caught in conflict and crisis. It's also our job, our sense of duty, to bear witness and share stories from our patients and staff to help you understand what's happening.

Thanks again for joining us for this discussion, which will last around 45 minutes. And wherever you're joining from today, you can submit questions for our speakers via the chat comments, the section that you have there on your screen. There are also live captions available on all channels. We're lucky to have with us two aid workers, both with many years of MSF experience across multiple crisis zones, and whose medical witnessing in Gaza has been so powerful.

I'll start by introducing Dr. Javid Abdelmoneim, who has a background in emergency medicine and tropical medicine. And he's here after serving as the medical team leader in Gaza this summer. He has worked with MSF in response to the West Africa Ebola outbreak and conflict settings. From Syria, to Ukraine, to Sudan. Welcome to you, Javid. Good to see you.

Dr. Javid Abdelmoneim:

Thank you for having me.

Avril Benoît:

Also with us, Dr. Amber Alyyan, a pediatrician with lots of experience in the region, having worked with MSF in Lebanon, Syria, Jordan, Turkey, Iraq, and Yemen, among other countries. She's MSF's Medical Program Manager for Palestine, Afghanistan, and Haiti. Thank you for being with us today, Amber. I know how busy you are.

Dr. Amber Alyyan:

Thanks, Avril. A pleasure.

Avril Benoît:

So just to get us started here, I wanted to cover one of the most complex questions that we often are asked about the war in Gaza. We talk about it being an extreme or exceptional conflict. Can you tell us, Javid, first, what to you makes this so unprecedented in your experience?

Dr. Javid Abdelmoneim:

Thank you for the question, Avril. Yes, good day, everybody. I've been with MSF 15 years now, so a good while. And what that means is that the Bosnia, Rwanda, and Darfur genocides are before my time. What I saw in Gaza was a war on the people, on the population. I think it stood out in two very specific ways. One is that in this, my seventh conflict, in my six previous conflicts, the population, the civilian population was free to move away from safety, move away to safety, I'm sorry. And here, precisely the opposite is happening in Gaza, where they're actually instructed, herded, moved into an ever-smaller space that's not fit for purpose and that is unsafe. The second bit, the second part of it for me specifically is to think, is to understand and be mindful of the use of the word war, I think. We have an occupying military power. We have a captive, blockaded refugee, mostly refugee population, who are extremely vulnerable and never allowed to return to their homes in former Palestine. And again, with the complicity of the international order in supporting Israel, that is something that I think is super dangerous for the future and exceptional at this time.

Avril Benoît:

Amber, do you have anything to add about what makes this so unprecedented?

Dr. Amber Alyyan:

I agree with everything that Javid had said, and I've worked quite a lot with Syria, and this reminds me a lot of Syria during the siege of Aleppo. That lasted for about six to eight weeks, and this has gone on for a year. So, there's this component, which is the population that is completely stuck, cannot move, and is being bombarded hour after hour, minute after minute. So, there's that component which makes this, the amount of destruction, the scale of destruction is incredible. And I think one of the more frustrating things, certainly for the population, but for those of us who have worked with them for many years, is just this feeling that no one, or at least the international powers, not only seem to not care or reflect on the Palestinians as sort of inhuman somehow, but also aid and abet the destruction that's going on, whether directly or indirectly.

Avril Benoît:

And as with Aleppo, as with Gaza, we have been screaming very loud about attacks on health care, attacks on medical workers. And so in that sense, it's also consistent with what we've always tried to do. I'd like to bring in right now a colleague of ours, Deputy Medical Coordinator Dr. Mohammed Abu Mughaisib, with a short three-minute video message from Gaza. We'll also get a glimpse of what his life was like before the war.

Dr. Mohammed Abu Mughaisib:

I had a house, family, every corner of my house, I remember, the living room, the bedroom, the garden. It was my dream to have this house. I was working with my wife to build and to have it like this, sitting, chatting, laughing, smiling, joking. We were buying whatever we wanted, sweets for the kids, chocolates, vegetables, fruits. We were planning and we had dreams. Our kids were growing in front of our eyes. We were planning for them their future. All of this suddenly on the 7th of October changed. Drinking water not available, food was not available. We went to Rafah in the coastal side, in what's called the humanitarian zone, which is not a humanitarian zone. It was a hell because strikes didn't stop and how I cannot protect my family on a daily basis. I managed to take my family out of Gaza to go to Cairo. Now I'm alone since February. From my place in Rafah, I moved maybe five times. I needed to evacuate. I struggled to go to the toilets, the shared toilets. The bath is busy and I have to wait. I'm far from my family. I feel lonely, mentally tired. I need to unite with them. My wife, my daughter, my two boys. The first thing, when the war stops, I will do my best to go to Egypt, to Cairo, to meet them. I will try to cross to Gaza City to see my house. Is it still standing or not?

Being displaced and separated from my family while continuing to work with MSF and provide medical care in Gaza has been one of the most challenging experiences of my life. Every aspect of my life has been affected by this war, from the constant fear of safety to the difficulty of accessing the basic needs and necessities. The situation forced us to adapt in ways that we never imagined. My work providing the medical care is a source of purpose, but the personal toll is too heavy. Being away from my family, from my loved ones. I know they're in a safe place, but still they are far from [me]. The only one message that really I would like to share with the world is behind every static, every headline, a real life in Gaza has been lost. Families are being separated. People are struggling to survive. My hope is that the world understand our shared humanity and shared our solidarity to work, to push for ceasefire and stop... stopping this war.

Avril Benoît:

That was MSF's Dr. Mohammed Abu Mughaisib in Gaza. Now, can I ask you both to react to his words and talk about the work of our Palestinian colleagues more broadly, who make up, they make up more than, well, I think it's much more than nine out of 10 of the 700 plus staff that we have in Gaza. Maybe, Javid, you could start with some reaction there.

Dr. Javid Abdelmoneim:

Yeah, I mean, I worked with Dr. Mohammed, sorry, I call him Abu Abed, so I almost called him by his familiar name. Dr. Mohammed, he was a mentor to me, he's a deputy medical coordinator, I'm the medical team leader, and he supported me hugely in my work. My first reaction is, if I'm truthful, a pang in my heart. I felt my heart go, oh, when he described himself being lonely and missing his family, because I think one thing that I took away from Gaza, working with my Palestinian colleagues, is their professionalism, their showing up, their compassion and dignity, despite living through everything which Dr. Mohammed described there. And I think to hear him say he's lonely, that professional facade was gone for one of the few times for me in my experience with him. And so it humanized him in a way that I haven't experienced him in a sense. So yeah, a bit of heartbreak, to be honest, to watch that. And he looked more tired in the second video than I've ever seen him. He's a cheerful person at heart. And so, yeah, I feel for him seeing that video.

Avril Benoît:

We certainly thank him for taking the time to record that message for us. Amber, what does it bring to mind for you when you think of your colleagues in Gaza?

Dr. Amber Alyyan:

I mean, I've been working with them for over five, six years now. And I have to say, they're some of my favorite, favorite, favorite people in MSF and in the world. And their dedication to the work and to the population and to health care is just...incredible, and I also have a hard time calling him Dr. Mohammed, but Dr. Mohammed is one of, really one of my favorite people in the world. I've never seen anybody so dedicated to MSF and the spirit of MSF, and not just him, but really so many of our colleagues in Palestine, and to hear, I agree with Javid, to see him, because he's really, he's lost a little weight, and it's not because he's not, he's not on a diet, although apparently in Gaza now they call it the, they actually have a very sarcastic approach to discussing the fact that they've got no food, but to see him losing weight, and just, he just looks so gaunt and tired, and they are, and I know he's missing his family, and I remember even at the very early days of the war, talking to him, and just being so worried about his kids, and I felt so relieved when he managed to get his family out, but it breaks my heart for him.

Avril Benoît:

Yeah, well, let's hear about your own experiences. Javid, you were in Gaza for two months this summer, June and July, and those were unbelievably intense months. Can you tell us about some of your experiences?

Dr. Javid Abdelmoneim:

Yes, I mean, they certainly did feel intense, and of course, without going back or having been before, I can't say whether they were more or less intense, and certainly the things about which I'm about to talk are ongoing, and happened even yesterday, and the day before in Gaza, and so I don't think it's any less intense now, potentially. I started writing things down, because so much happened that affected the project, and our work, and my colleagues, that I thought, you know, as part of the witnessing, I kept a log of a timeline, and I guess three things, or two things I'd like to at least point out very much from my time there, for example, just in the space of nine days in July, there were four mass casualty incidents, so where there's an influx of wounded people just to the emergency room at Nasser Medical Complex where we were working, where we were running the trauma orthopedic and burn unit. So of course, we're entirely invested in the trauma chain and receiving patients into ER and supporting the emergency room. But just in those nine days, two of these events which were strikes within the humanitarian zone resulted in 568 injured people and 162 killed just at Nasser. And for me that does reflect the indiscriminate nature of the attacks which failed to differentiate between civilians and Israel's stated military targets and really paints a picture of the strain the healthcare system was under to pivot an entire healthcare, an entire hospital to a mass casualties. It is a huge undertaking to do that every other day but also then to think of the human toll there is quite staggering. And the statistic now is that one in 23 people of the whole Gazan population is injured and one in 55 people the whole Gazan population are killed. And it's because of mass casualties of that sort but also there are silent killings.

I guess the second thing I wanted to tease out was a further example of quite how unsafe it was such that in five days of July alone, between the 9th and 14th, three of my colleagues, one an operating theatre nurse working with us in Nasser had his child killed after their home was struck in Nuseirat in the middle zone, his youngest child of four. And then an anesthetic doctor of mine, a colleague of mine working in Nasser also on the 13th had his home destroyed in a strike in Khan Younis in the southern area. His brother, his son, his brother, his brother's child and his brother's other child, so three family members, one was killed, one had a spinal injury, and one was hospitalized for weeks, and he was rendered homeless. And the very next day a nursing colleague of mine up in Gaza City, so this is in all three areas of Gaza, had two of his three children killed and his third child with a life-changing leg injury after their house was struck. And these are just people in my team and there were multiple MSF teams across all of Gaza and this is just the experience that of just the people that I know, it's not me compiling MSF-wide statistics here. And it just goes, for me it showed that all parts of Gaza, no matter where you lived in the strip, north, middle or south, were unsafe.

Avril Benoît:

Moving through, is there a patient whose story you'd like to share with us?

Dr. Javid Abdelmoneim:

Yes, I missed a part of that but you asked about a patient story. I think there is one patient that for me I want to share specifically. He's a child, he's a boy who was injured at the Nuseirat hostage rescue and that happened only on my second day in Gaza on June the 8th and he was discharged from our ward on July the 20th and that long period of stay just goes to show quite what physical recovery he needed. He at discharge had an amputated left forearm, he had a shattered femur with an external fixator still on that was still healing and he also had had a brain injury which caused a concussion and memory loss and seizure. I think over the weeks that we had him, I got to know him and his mother only very slightly. She wanted to call her brother who was living in Belgium to try and stimulate the memory of this boy, he was about nine or ten, to see if it would jog his memory and he had the most beautiful smile is what I remember. But for me what's so, aside from the fact that we got him to physical healing and let's not forget that the mental healing is yet to come and something we should talk about later for the population, for me what was so sad about this was that he was injured in the hostage rescue and the Israelis bombed a marketplace as a distraction for the covert operations on the other side of the Nuseirat and that mass casualty that day was huge it was only my second day in Gaza the numbers were 698 injured and 276 killed on that day alone and he was one of them and we had other children on the ward for nearly as long but he was our longest stay and the last boy that we discharged from Nuseirat.

Avril Benoît:

These mass casualty events with so many patients coming in all at once it's just astounding to think how difficult it is. We are starting to get questions from those of us who are joining us online and I'd like to ask Amber for you to take this one on from Jojo who's tuning in from Japan and it's a question that I think you're perfectly placed to answer what are the difficulties in organizing logistics in Gaza right now and more broadly how does MSF organize itself effectively in crisis zones where the circumstances are always changing?

Dr. Amber Alyyan:

Come work for us and you can you can see how it's done because we don't have that much time for me to go into all the detail but it's very carefully done with wonderful staff both inside and outside of the country and in this case for Gaza. For logistics though it's very complicated right now our supplies are not getting in in any efficient way we've got trucks like trucks lined up at the borders trying to get in and not entering. We have fantastic staff Palestinian staff who've been with us for many many years who from day one of the conflict have been organizing, whether it's to setting up makeshift structures, turning buildings around, rebuilding things that have been destroyed with whatever resources they've got inside the country. And then what we can't find inside, we try to bring in. And that's where a lot of our complications are coming right now. We have huge problems with even getting things like soap for the population, for our own staff. But logistics, it's a huge endeavor. It involves, it can involve things like tents and water, and it can involve things like medical supplies. And so we've got teams working around the clock to make sure that we can get things in a normal, in a typical MSF setting. Gaza is not typical in any way in that regard.

Avril Benoît:

You mentioned soap and the lack of availability of soap. Why does that then become a medical issue for us?

Dr. Amber Alyyan:

I've actually, I've never, I think this is something that's like, it's so simple and yet it's so shocking to me. And every time I hear about it, I cringe quite a bit. It's not available in Gaza. And I've never, ever worked in a place where soap wasn't available to the population. They don't have clean water or it's salty water, or they don't have soap at this point. And medically speaking, what we're seeing are people who haven't been able to bathe in months. We have huge problems with things like scabies, lice, but on top of that, what we're seeing more and more of is like full body, something we would call impetigo. So full body infections, skin infections that are occurring in the whole population, but in children, especially, we're seeing this. And what it means is things like scabies and lice are never easy to treat, but you can treat them. When you get super infections, so bacterial infections on top of that, it becomes even more complicated. They're painful. They're very complicated to treat because they require antibiotics. And it's something that sounds so simple, but it's not that the population chooses to not be able to keep better hygiene. They physically do not have access to soap. And when they do have access, it gets looted because there's not enough to go around. And the soap making factories in Gaza cannot function. I mean, it's just, it's because they can't get the supplies in to make basic, basic, basic things.

Avril Benoît:

Well, I would like to explore with you both, what are some of the other medical needs. But Amber, you in particular earlier this year, you were part of a delegation of doctors who met with officials in the US government and with the United Nations. And you described the medical impacts of Israel's bombing campaign using weapons that the US and other allies were supplying and a warning to those tuning in that some listeners may find this disturbing. But can you tell us about the kinds of injuries that we see from the use of explosive weapons in these densely populated areas of Gaza?

Dr. Amber Alyyan:

Yeah. So Gaza is very densely populated, like you say, so it's 2 million people in a very, very small area of the world. And when you have these huge, like thousand pound bomb type capacity that are detonated in urban zones, what we see are, well, we call them polytraumas, so it's deeply explosive injuries that can be, and this is quite graphic, but that you can have orthopedic injuries, so injuries to bones, to limbs, but as well as injuries to abdomen, back, brain. And then on top of that, because they're explosive, there's also a component that is burning. And so we see a lot, a lot of people with these polytraumas, and the heavier the bombardment, the worse off for the civilian population in that way. And so this is where, when Javid was talking about mass casualties, you don't get a mass casualty where it's like 12 people and they're fairly easy injuries to deal with. They are very, very complex injuries that require huge surgeries, and not one surgery, but repeated surgeries over time, over months. And that's in good conditions of life where you can take care of the injuries afterward, where you can clean them properly, and where the population is safe to come back for follow-up appointments and follow-up surgery. And when you've got the whole thing combined together, it's just a complete nightmare for the outcome for these patients.

Avril Benoît:

And Javid, what are some of the other medical needs in Gaza right now? We often, well, since the beginning have been expressing concern about the lack of water that we heard about, the lack of food coming in. Can you describe for us what you saw as the medical team leader?

Dr. Javid Abdelmoneim:

I was muted, I think. You can hear me now. Yeah. Yeah, indeed. You know, I was medical team leader over three sites. Two of them were medical points, so doing primary health care and then at the trauma unit. The needs at the primary health care level were certainly, as Amber described, skin infections, diarrheal infections, respiratory tract infections, eye infections. So lots of avoidable diseases that are directly linked to water and sanitation and overcrowding. And it wasn't by accident that polio was declared, a resurgence of polio happened on July 16th, 17th, if I remember correctly, sitting in the coordination meeting. I have to say that a shiver really went down my spine because we had the water agencies there describing to us the state of the water and sanitation system, describing a thousand kilometers of sewer pipes destroyed, describing almost total standstill of solid waste management, including 60% destruction of all heavy machinery, fuel. They're only receiving some low percentage of fuel, if I remember correctly, just 27% of their fuel needs in July. And fuel is needed to pump water, to purify water and to move clean water around to the population to have clean drinking water. And with all of that destroyed, with immunization uptake reduced, with the extended programs of immunizations being frail, then we saw this polio resurgence. And that just goes to show with this systematic dismantling of the water and sanitation system, of the healthcare system, it leaves you open to these needs. And the second round of polio vaccination should have started today. But beyond that, it's mental health needs that I think I would really like to bring out, we can only touch the surface of the mental health needs from patients who have been traumatized, losing limbs, suffering injuries, being burned, but their families, but every Gazan who's had to live through what they've lived through for the last 12 months. On top of that, there's silent killings, what are deemed silent killings, the needs for healthcare are still there. And when dialysis beds for kidney failure are drastically reduced, or cancer investigation and treatment is simply not happening, or insulin cannot be imported or is difficult to keep because of a lack of fuel for fridges, and diabetics can't then get treated, you're having a higher, an excess number of deaths, due to these non-communicable diseases, these entirely treatable chronic diseases. And so that's another feature, which takes estimates of death tolls from the Lancet and other leading generals, leading medical journals, well into six figures, approaching 300,000 in some modelling. And so these are the medical needs that are not being addressed. evacuations for complex cases were not happening in the time that I was there, there was only one successful evacuation in the end. And that's because the Rafah border had been closed and, and, and Israeli military activity had started down there. So you've got a whole gamut of health needs right across the healthcare system, all in the context of serial evacuation orders and closures, for example, just in the first eight days of July, three evacuation orders in the north and in the south, resulted in the closure of 13 medical points for primary healthcarecenters and three hospitals. And there have been evacuation orders just this week for the three hospitals up in the north government there, Kamal Adwan being one of them and Al-Awda.So this is putting health provision effectively at a standstill in those areas and makes it very, very hard to care for the population.

Avril Benoît:

Yeah, and on this question of the medical evacuations that you mentioned, Amber, maybe you can describe why more people are not being evacuated when they need follow-up care, more advanced surgery, post-operative care, and all the things that cannot be provided in Gaza.

Dr. Amber Alyyan:

So about 15,000 people have asked for evacuation for medical purposes, and only about 5,000 people have been granted the evacuation. It's multifactorial. In order to be evacuated, there's a process that the Ministry of Health organizes with support from the World Health Organization and a number of organizations that are working inside Gaza. There are very strict security restrictions on who can leave. So the people who are granted are often children and women or elderly people. But as I said, 15,000 have made the request and only 5,000 have been allowed out. There's also a question of where they will go. Quite a lot of these people are already in Egypt but don't have access to comprehensive health care services, even on the evacuation. And then there are other countries in the world, and again, this is one of the things I think that's very frustrating, is that the countries that are helping to fund this war are not taking on these cases of children and women and men who are also, whether with chronic diseases or cancer, who need support, and they are not being allowed in. There are very few countries accepting patients coming from Gaza and very few who are doing what it takes to get people out.

Avril Benoît:

Amber, we have a question here from Dina, who is tuning in live, and we welcome these questions for this discussion about what's happened over the last 12 months in Gaza. She asks if you could talk a little more about the mental health response in Gaza. And she's also interested to hear how MSF is collaborating with local organizations there.

Dr. Amber Alyyan:

So for the mental health response, the needs before the war were great. It's not that the war started on October 7th or October 8th. This has been a siege in Gaza that's been going on for many, many years, but as well war after war and displacement after displacement for decades, in fact. And so, and what we see in Gaza and what we've seen in Gaza over time is a sort of generational trauma, basically. Various wars, imprisonments, torture, lots of history of distress within the population and going across generations. So there are, connecting the two questions, there are local organizations actually that are working on mental health and some of them very, very good. But the needs are devastatingly high. We currently, in all of our programs, have an integrated mental health component. So we ensure that we've got psychologists or counselors who can work with the patients. It is very difficult for our staff, and I think that to work with these patients, because they themselves are also victims of the war. And this makes it very complicated. It can be done and it can be done well, but it's very complicated because our staff also need breaks and it's very troublesome. I think it's not even beginning to touch it in terms of seeing these people, parents, children who are injured, who are terrified to go to an operating room because they don't want to be separated from their parents because their parents are the last people they've got left on the planet. And so when we talk about mental health support, it's not like you sit in a nice room. There are no nice rooms. So we put them aside where we can to have some kind of privacy or we do group sessions. But it's really every single level of care brings in a component of mental health support to the patient because the needs are so, so high and that level of empathy is so greatly needed on every level, but not just for the patients, but for the staff as well.

And sorry, for the second question in terms of local organizations, yes. So to understand about Gaza and the West Bank as well, is that for many, many decades, these are areas of the world or these territories have been under a military control, military occupation, where there's military control, but there's not necessarily governmental control. And this happened from the 60s to about the 90s. And then there was a government that kind of came in, the Palestinian Authority. But during that 30-year period, there was a huge network of civil society that took over the role of what a government normally does. So providing schools and healthcare services and a wonderful, wonderful network of civil society, but is very competent, skilled. And so we do our best to work with them because they know the population better than anybody and they've been taking care of them for decades. And so we work with them a lot when it comes to, whether it's partnerships for referrals, whether it's partnerships for follow-up, in whatever way we can. And we were working with a local women's organization in one of the primary care centers we were working because they have such a wonderful connection already with the population and had asked for our support. They were doing the women's health and we worked on the primary care and the response for non-communicable disease.

Avril Benoît:

And from your perspective, Javid, then on the ground, this mental health issue, we have heard that there were even children who asked to just be allowed to die. What did you see of that spark of life, of joy among children that were either in the hospitals as patients or as families, were either in the hospitals as patients or as family members or in the community?

Dr. Javid Abdelmoneim:

I think, yeah, good question. Children are incredibly resilient, but at the same time, their brains are sponges, right? And an eight-year-old, a nine-year-old, what they're going through, this profound instability, this profound fear for their safety, seeing. every family has loved ones killed in Gaza in front of them at this time, being hospitalized, losing a limb, as the largest cohort of amputee children in modern history is now living in Gaza. And I don't know about any of you, but the story I tell is that, you know, I remember when I was four, falling off a wall. I didn't even break a limb, but it was such an experience. And that was it, it was over the moment I landed. It was long enough, I was falling long enough to think, gosh, this is going to hurt. And then it did. But it's a silly story, just to say, I remember that. And it's, it's a thing. It's like one of my core memories from childhood. Just, just, I just think how these children, I don't think you can recover, you don't physically, mentally recover from a year of what's happening. And so we would see children, again, it was a girl from Nuseirat, and she, I wasn't on the wards, but it was a, it was a night shift. And there was a, we had, we did not get the warning, but there was a, an airstrike from the Israelis on a block, exactly across the street from our ward, outside the hospital complex on an apartment block. And it was a huge explosion by all accounts. And we only had about 20 minutes to move people away from the windows in case there was going to be a force and glass shattering. And this little girl who had been, who had extensive burns from the Nuseirat hostage rescue from the explosive injury. And my colleague, Nurse Laura came back and Lisa, and they, they, they, they described how the look of terror on her face, and how she clung to their body, don't leave me when she heard that explosion, despite being in a safe space around, you know, and, and that's the type of thing that doesn't leave you. And she's one of 10s and 20s of thousands of people struck in this way, mentally. So I fear, I fear for, yeah, for the future mental health, well, today, but for the future of Gaza also.

Avril Benoît:

Yeah, and as we we're coming toward the end of this discussion, and I do have a question for you Amber. It was sent to us on Instagram. How have our own staff been coping with the trauma they've endured personally during this war? And how is MSF taking care of staff in Gaza? You had mentioned that they just don't get a break. They're working straight through they're fleeing from place to place as we heard. How are they coping and how are we helping them?

Dr. Amber Alyyan:

Well, like I said before these are these are my personal heroes and these are people who from day one We're saying okay. We're going we're going to this hospital. Okay, we didn't ask you to go But they just took the initiative and they and they went they went to Shifa They went to Nasser and they just kept working and they've been doing this So when I say they don't get a break, it's we've been asking take a break And we try to encourage breaks But on the one hand, I think that they don't take a break because take a break to do what there's their homes are gone And they've got nowhere to take a break. And on the other hand, I think that Because they are dedicated health care workers that for them. This is part of their coping mechanism This is I can't take a break I can't stop because then I have to realize exactly what's happened to my family into my home And so working is a way of surviving we try our best to help with whether it's providing psychological support or financial support or non food item types of support clothing shelter We try our best but the needs are so great and like I mentioned earlier The supply situation is so difficult that getting things into them is even complicated That when you have when you're waiting for months to get tense inside for the whole population and your staff as well Makes it very frustrating but it's with a lot of efforts. We have entire teams dedicated to trying to take care of our staff But it's it's not a fraction of what we would want to be able to do

Avril Benoît:

All right, well the final question for both of you now that we've been receiving so far how can people help? Maybe start with you Amber and then we'll go to you Javid.

Dr. Amber Alyyan:

I mean, well, I think speaking up and talking about this, recognizing that we're talking about human beings whose entire story in life doesn't exist around a war, and whose entire perception in the world or their being in this world doesn't revolve around who they are vis-a-vis another party. And so recognizing that already and looking them as humans. And then I think, as Americans to be able to speak out and say that this is not, this is not acceptable, this war has to stop, we cannot be taking part in anything that allows us to fund this, but also to not stop it, to restrict aid going in. So I think anything that Americans can do to speak out, that's what I would speak on. And then for other nations as well, I mean, how is your country involved? And speaking up is very, I think it's very necessary, because we can do a lot with MSF. And so sure, if people want to work for MSF, I'm happy to have people who come work for us. But there's only so much you can do as a humanitarian worker. And there's so much more that governments need to do. And I think populations speak to that and need to be able to address that.

Avril Benoît:

Javid, how can people help?

Dr. Javid Abdelmoneim:

Yes, I can only echo that really, I think we all just need to challenge narratives. And I think, vocally, as much as possible, recognize Palestinian humanity. And one thing that I grew up, listen, I'm half Sudanese, my dad is from Africa, I grew up during the apartheid era in South Africa, and we checked our grapefruits in the supermarket. And if it was from South Africa, we put it down. And I firmly believe in boycotts. So boycott Israeli produce. I think this is something that's concrete and something you can do as a person, especially if it comes from settlements. But yeah, I think hold your politicians to account. The law is the law. And we must treat all nations not above the law, right? I would like the same standards of law applied to Israel as any other nation.

Dr. Amber Alyyan:

If I could just add, sorry, just to take it back home to yourself, I mean, so 587 healthcare workers have been killed in Gaza. In the US, that's the equivalent of 92,000 healthcare workers. That's just, it's insane. 16,000 children have been killed. In the US, the equivalent is two and a half million kids. Just to bring it back home, if this were happening to me, what would I want somebody to do for me? And I think that's how you answer the question.

Avril Benoît:

Yeah, thank you for those. Obviously, we all have our own personal views, the work we do, and as the CEO of Doctors Without Borders in the US, I can also say that we are independently funded by people like you supporting us in all of our humanitarian action around the world, and of course, as well in Gaza. So if you know about this webcast, you know about our website. It's doctorswithoutborders.org, where you can find out more information. And we also have an international website, msf.org. To both of you, I just want to thank you so much for bearing witness today, for sharing your experiences, Dr. Javid Abdelmoneim, and Dr. Amber Alyyan. We really appreciate you taking the time. And also to Dr. Mughaisib for the video message from Gaza. You know, nicknames aside, we salute all of our Palestinian colleagues who are working day in, day out under extremely tough conditions. Our hearts are with you. We think about you every single day. I'm Avril Benoit. Thanks to all of you for joining us. And apologies if we didn't get to your question, but please stay in touch. Stay connected with MSF. You can visit our website again, or follow us on social media, or you can email us. Here's our email address for this sort of thing. And if you have a question, it's [email protected]. Bye for now. Take care.