Saira Hussain: Medicine Under Siege, Famine, and Starvation in Gaza

In this episode of Not to Forgive, but to Understand, we are joined by Saira Hussain, an anesthetist who has worked in Gaza at Nasser Hospital in Khan Younis through humanitarian deployments with Medical Aid for Palestinians and IDEALS.

This conversation explores what it means to deliver critical care inside a collapsing health system. Drawing on firsthand experience, Saira discusses blockade conditions, mass-casualty medicine, famine and forced starvation, and the daily ethical and clinical decisions faced by medical professionals working under extreme constraint. The discussion also looks beyond the present moment, asking what rebuilding medical education, infrastructure, and professional capacity might entail in post-conflict settings.

This interview was recorded in September 2025, during a period of enforced starvation in Gaza. It remains acutely relevant today, as United Nations reporting indicates that over 400 Palestinians have been killed since the October ceasefire, underscoring the ongoing humanitarian and medical crisis.

00:00:00
Introduction

00:02:37
Collapse of Gaza’s Health System

00:07:01
Why a Doctor Goes to Gaza

00:19:36
Practicing Medicine Below Standards

00:26:00
Patient Testimony Under Siege

00:28:45
Mass Graves Near Medical Facilities

00:30:49
Blockade, Aid Restrictions, Hospital Failure

00:39:43
Patterns of War-Related Injuries

00:40:14
Famine and Enforced Starvation

00:44:04
What Global Reporting Misses

00:46:30
Rebuilding Gaza’s Medical Community

00:49:30
Personal Cost of Medical Witnessing

00:50:59
Medical Ethics After Atrocity

00:53:55
Unprecedented Weapons and Trauma

00:58:12
Aid Sites and Civilian Death

01:01:58
One Image for the World

Transcript

0:00

When I worked in the maternity unit and there’s a lot of pregnant women in Gaza. Having a baby is a time of joy. Should be a time of joy. It should be a time of celebration. And I remember every single new mother, whether she had other children or it was her first baby. Just had this blank look across their face. There was no joy, there was no emotion. There was nothing. And there was this newborn baby there. And we'd hear the bombs going off all the time. You would hear people in pain. And there would be a new mother with this blank look on her face. That, to me describes everything Today we’re joined by Saira Hussain, an anesthetist who has worked in Gaza at Nasser Hospital in Khan Younis through humanitarian deployments with Medical Aid for Palestinians and IDEALS. In this conversation, we discuss what it means to deliver critical care inside a collapsing health system, including blockade conditions, mass-casualty medicine, famine and forced starvation, and what rebuilding medical education and infrastructure could mean in post-conflict settings. This interview was recorded in September of 2025, during a period of enforced starvation in Gaza, and remains relevant today, as UN reporting indicates that over 400 Palestinians have been killed since the October ceasefire, underscoring the continued humanitarian and medical crisis. I want to just start with this introduction, which comes from a report by the UN Human Rights Office that on 31st December 2024, asserted that Israeli military attacks on and around hospitals have pushed Gaza's health care system to the brink of total collapse. Approximately 80% of Gaza's healthcare system has been destroyed since October 2023. Saira, what moved you as an anesthetist in Australia to travel to Gaza and provide medical aid in such extreme conditions? Let's remember that this is not your first experience with humanitarian work. Previously you have been to Papua New Guinea on four medical missions. Thank you, Sabah. As an anesthetist, our profession is at the forefront of obviously providing anesthesia, but also the forefront of pain management, resuscitation, and critical care. So our practice covers a wide area of medical conditions or situations. And I remember after the retaliation by Israel after October the 7th, I remember seeing many instances of an overwhelmed, struggling healthcare system, managing the casualties of explosions and the intense bombing that occurred after that date. But what I saw was a very young medical community, a very junior medical community, managing terrible injuries in a large population of injured people with limited supply. And I felt very strongly as the days went on and I saw more and more of this, this was not coming across mainstream media. This was all through social media platforms or through other humanitarian organizations that I communicate with. And I became very aware that there was this desperate need for experienced senior medical professionals to get to this situation, to try and provide hands on the ground, help, guidance, and tuition for the junior medical staff that were there. Which then begs the question as to why were the staff that I was seeing so junior; treating these mass casualties at the time? And as an educator, as a teacher, as somebody with 26 to 27 years of experience, I felt really compelled to bring my experience and my hands to help these young doctors and nurses. And of course, the reason that this situation was being managed by such young health professionals is because the senior health professionals had either left through the Rafah border at the time when Egypt was open because they could afford to leave and wanted safety for themselves and their family, which no one can criticize at all. They had either been killed or the abductions had started of senior medical professionals. And so what happened was that all the people that would guide and manage and triage and conduct an organized response to mass casualty events were not available. And that was then also coupled with the immediate blockade of the movement of supplies through humanitarian organizations such as UNWRA, such as the WHO, medical organizations, which provide a lot of the medical equipment to the hospitals and other clinics, etc., in Gaza. So I began immediately finding out which aid organizations were on the ground and able to assist me to facilitate them. So it was really, I felt very compelled. I felt it was like my moral duty because I'd seen something and I couldn't look away. I had the skills, my social background is favorable. I was able to take time off work. I had no financial restraints to not going. So I didn't really feel that there was a choice for me. So can you tell us because you went there at various periods? This is what I gathered from some of the interviews you had. Tell us about those different periods you were there and the changes you saw in terms of the patients you spoke to, you interacted with, and the people who were there helping out the medical care system and otherwise. So the first time I went was in October 2024, and I was part of a team of three; myself, a general surgeon, and a vascular surgeon, both from the UK. And we went with the UK NGO Medical Aid for Palestinians. This NGO has been on the ground in Gaza and the West Bank Palestine for the last 60 - 70 years. So they've got a very high reputation, held in very high esteem, and their main tasks that they do is education, especially in terms of surgical education for the surgeons. Also mental health, mental health education, as well as providing outreach clinics. And the two surgeons that I accompanied had been in Gaza before this particular conflict. And so they had seen a very different Gaza from the Gaza that we saw when I went in October 2024. They had seen in Gaza where you had an organized healthcare system, although organized in the face of it being a system that was subject to, I call medical apartheid. Gaza is very restricted in the types of medical services that it has been able to offer, and that has been imposed by the Israeli occupation. So, for example, if you have cancer, you can certainly have a surgery for your cancer. But if you require chemotherapy or radiotherapy or anything else to finish the treatment of your cancer, you have to get a permit. And those permits can take months to get to travel outside of Gaza, to go to Jerusalem or West Bank or Jordan. And those permits are subject to all sorts of red tape and bureaucracy and if you're a child, you have to obtain a permit for yourself to travel and then for somebody to accompany you. There's also a lack of other sort of specialist medical equipment and personnel, again imposed by the occupation, which facilitates, for example, travel to Egypt to get medical assistance again, which requires a permit, which requires money, requires a whole organization. So health care in Gaza prior to this conflict at the moment was also subject to heavy restrictions. So you already have a population that's on a back foot with regards to health for one reason. And when I spoke to my colleagues that I traveled with in October, they had visited Gaza, when they had, the medical schools were still standing, there was medical education, there was nursing education. Curricula were running as per normal. There was surgical specialty training, specialty training throughout all of the branches of medicine. The Gaza that we went to this time was first of all a lot of the infrastructure had been destroyed. The places where medical education simulation was held had been destroyed. And a lot of people had been displaced, certainly from the north moving down to the south, from the south up to the middle area. And medical education, nursing education has literally gone on hold. Added to that, you had a redistribution of very junior doctors into skill sets that weren't normal to them. For example, you had somebody who was a general practitioner suddenly thrusted into the role of a surgeon, and this was done because medical personnel were needed to fill certain roles, but you only had a certain amount of medical personnel left because the senior people were people who had money could leave or had been abducted or had just disappeared or been displaced. So we walked into chaos in October 2024, we walked into a place that was running on very low supplies, availability of supplies wasn't guaranteed. However, there was still some hope and some kind of organization. So we met with the senior officials of the hospital, the Ministry of Health. We were shown around the hospital. We were shown which parts were functioning, which parts weren’t functioning, and we were showed where medical equipment had been salvaged because back in January 2024, Nasser Hospital, where I was based, was the subject of a siege. And during that two or three month siege, they destroyed a lot of the medical equipment, abducted a large number of doctors, some who still remain their whereabouts still unknown, abducted a large amount of nursing staff. And also destroyed, for example, the dialysis center. They destroyed the warehouse with all the medical equipment that was brought in by international NGOs. And so we came in really with very little knowledge of what we were going to face. But we came into a community within that hospital that was doing its very best to cope with the patients that it was dealing with. At the time the hospital mainly housed people, the staff and administrative staff, and staff would come in daily on a bus and leave unless they were doing a 24 hour shift. The international staff at the time when we were there, there were about 15 of us maximum at one point. We were housed in an area in the hospital. We were allowed free reign of the hospital. We could go anywhere we wanted. Any department everywhere was open to us and it felt like a very safe place to be. The types of cases that we first saw when we got there. There had been a lull in missile attacks and strikes at the time. So we were able to deal with things like cancer and gynecological conditions such as fibroids, which are very painful conditions that weren't related to the consequences of any kind of assault or attack. And in that time, we dealt with people whose cancer had become very advanced that really the care that we were giving them was palliative to relieve pain. None of it was curative. We dealt with a large number of children who had not been able to receive appropriate antibiotics due to the restrictions on medical aid entering and had developed lung abscesses, which is necessitated removal of parts of their lung. And in any other health system this infection would never have got to that point. And I'm talking two year olds, three year olds, four year olds. I worked in the maternity unit and I saw women who were anemic, who were carrying babies. In any other health care system, you would receive iron supplementation, you would have blood tests from a very early age. You would receive repeat ultrasound scanning. There was one ultrasound available, and sometimes it was working and sometimes it wasn't. So very often women were not receiving antenatal care. They weren't able to have any sort of support that their baby was developing properly. And at this time there wasn't the enforced starvation that we're seeing currently now. And people were still, as we would consider them, to be malnourished. After about six or seven days, the military campaign intensified and we started seeing mass casualty events. And that's when the hospital system completely broke down because you would get large numbers of horrendous injuries come to the hospital all at once. And Nasser hospital is a very big hospital. It has three separate buildings where operations can take place. And when these mass casualty events which occur usually due to airstrikes, large explosions in areas where there is very little shelter. So, for example, tent encampments. People would need immediate critical lifesaving treatment and this would occur in large numbers. So when you add that into the mix of a health care system that is really trying struggling with fairly junior staff and limited supplies, you have to triage patients in a way that you would never triage patients in your own place of work. For example, in my place of work in the UK or Australia, if we had a situation like that in Australia, the UK or in the US. There would be a number of disaster plans that would be brought into action, there would be people mobilized from other areas to come and assist with these mass casualty events. This does not happen in the hospitals in Gaza because there aren't the personnel to mobilize, there isn’t the equipment to use, even if you can mobilize personnel. There's only so many operating tables, there's only so many surgeons, is only so many scalpels, that only so many people can do very little with what little that you have. And so as a clinician coming from outside into Gaza, into this event I felt that I was making decisions that I would never ever make in my usual area of practice. But I had no choice. I would do things within my area of practice that I would never consider doing at home if I was at work in my usual area of work. But it was a case of whether I do it and accept that this is below the level of practice that I believe is appropriate for me or I don't do anything at all. And that's a really hard decision to make as a clinician when you tenet is first do no harm. And there's a real risk that some of the things that we do or couldn't do or did do or didn't do to the standard that we would expect, may have caused harm. But we were put in that decision where to do nothing wasn't really an option. So we did what we could at the time. In October 2024, during the months that I was there, the bombings intensified and the number of casualties arriving to the hospital increased. But that also meant that you had a large cohort of patients that had arrived maybe two weeks before that required repeat operations or repeat surgeries or repeated care. And when you had the constant influx, we were getting bombings three or four times a day when we had the constant influx of new casualties arriving, it became overwhelming. The wards became overwhelmed, pain management became a huge issue because, first of all, strong pain management drugs weren't available readily. They are subject to stringent administration, so they have to be signed out and given to staff, etc. etc. and managed documented. This was not possible in this kind of situation due to the sheer numbers of patients. So patients, if they were able to receive analgesia, weren't getting what we would have liked them to receive with the nature of their injuries or they weren't receiving any analgesia at all. And follow up for patients was also very difficult because we would naturally follow up any patients that we provided care to in the days following, this became very difficult due to the number of new patients arriving every day and the nature of the injuries that were arriving every day. So the standards of practice that we adhere to, for example in the UK, Australia, it was absolutely impossible to do that even with the best will in the world. I would love to be able to like, understand or have an example of how you had to make those choices that were below par in those kinds of situations where obviously because of the lack of equipment, because of the lack of facilities around you, it was impossible to maintain the same standards you would in a normal situation. So could you take us through actual examples of what you experienced? So I'll fast forward to July 2025, when I was recently in Gaza with again a British NGO called Ideals. Whose main remit is burns, plastic and reconstructive surgery. So this time my team was myself, burns and plastic surgeon and an orthopedic surgeon, one from the UK and one from Canada. And we were sent as a specialized care team to address the huge numbers of burns, injuries, amputation injuries, wound infections. By this time, you can imagine the number of this cohort of patients was absolutely huge. During my time there in July, there were a number of missile strikes which resulted in people sustaining major burns. One such example was a family, a husband and wife. The wife sustained 40% total body surface area burns. Now, that type of injury has a very high risk of death. Even with treatment in a specialist burns unit, there is no specialist burns unit in Nasser Hospital. There is no specialist burns unit operational in Gaza right now. These types of patients require a number of professionals to immediately act upon them to maintain their blood pressure, their fluid status, infection control. They will require immediate surgery to debride dead tissue from their burns and they will require an intensive care bed, and to stay on a life support machine asleep probably for a good couple of weeks because they will need repeated returns to theater to manage the debridement of their burns if the tissue becomes infected, etc. if they’re going to get skin grafts. And also a burn injury is a huge insult to the body. So the body's normal physiology of maintaining blood pressure, maintaining their heart rate, just general life is stressed to the point where it needs constant support. So you need support for the breathing, you need support for the blood pressure, you need support for just your fluid balance. And those will require specialist equipment such as intravenous lines into major arteries of your neck. You need a highly skilled, trained nurse to manage these parameters, 24/7. minute by minute, because things can change very quickly. Not only is there not a specialized burns unit in Gaza at the moment, there is an absolute lack of intensive care beds. So any patient, for example, like this burns patient who require an intensive care bed, there is literally not one available because there is another patient in that bed. That bed will only become available when that patient gets better or dies. Nasser hospital back in October had about 20 intensive care beds. They've had to somehow increase that to around 50. 50 intensive care beds, meaning that you can provide some kind of advanced life support for a patient who cannot remain awake that needs to be asleep on a life support machine while their body is supported in its healing process. These beds are not available. So what that actually means is instead of staying asleep and being supported on life support machine, you are woken up into full consciousness, when 40% of your body area is burned, severely burned. You may have sustained other injuries, usually the other injuries that you sustained or fractures or partial amputations or shrapnel wounds or head injury. Adding to the fact that you will be sent to a normal ward where the air conditioning probably isn't functioning, where the only airflow is by keeping windows open so that flies can come in. And when I was there, it was 30 degrees and 80% humidity. So if you can imagine how that will affect burnt tissue and the healing of that or the non-healing of that tissue, the infection rates, add into that unavailability of the correct antibiotics. So we would administer antibiotics that we had rather than administer none. However, that will then contribute to the development of resistant bacteria. When you give antibiotics that aren't appropriate for that infection, you create antibiotic resistance. But as clinicians, we had to choose whether to give the antibiotic and give possibly some cover for infection or not give it, and then know that this person is 100% going to get infected and septic and the tissue is going to die. The infection will go into their bloodstream. So we choose to give what we have. That's an example of where you have to make a choice, where first do no harm and what should we do for the greater good. But it's a difficult decision and doctors and nurses in Gaza make these decisions every minute. Add to that, the lack of appropriate analgesia. Burns and especially healing burns are extremely painful. They also require a lot of nutritional support. And as we know, there is an enforced starvation in Gaza right now. Children with these kind of burns were not able to receive adequate nutrition. We saw huge. poor wound healing in children because they haven't got food to eat. They don't have the specialized diet that you would give a child who receives severe burns to help with regeneration and wound healing. You are the medical practitioner who's actually going to these places where, of course, there is war, there is a deficiency in terms of facilities of medical care, of nutrition, of adequate nutrition. What are the patients telling you when you're interacting with them? I know that you learned Arabic for a few months before you went there and you did complain in one of your articles by saying that you were insisting that the other people you were working with, the other medical practitioners, that they speak Arabic to you, but they were switching to English. So I caught that, but what was important for me was that you did understand Arabic. You do understand Arabic. So with these linguistic skills, what did you hear patients talk about? Patients generally were very accepting of the fate that had been given to them. They were in a medical facility. They were being provided with the care that was possible. They know that there is a blockade of supplies. There's a blockade of personnel. Everybody was very grateful for any care that was given to them. We would often take food for people if we had powdered milk, we would give it to the caretaker of a child. I say caretaker because the person looking after the child might not be the mother or the father or even a relative, because very often when there was a missile strike, the whole family would be injured, some of them would have died. We often looked after children multiple times. We never saw an adult with them. We often saw children with younger adults. Who might have been a cousin or a removed relative that had come from another part of Gaza to take care of very young children. And in certainly in July, people were generally exhausted. If there was any talk, it was usually about the availability of flour or what's going to happen next? It very much, in July, was a day to day life for everybody in Gaza, patients, staff, everybody. Because the situation was literally changing hour by hour and I imagine it's exactly the same now, if not worse. You also mentioned something that may seem to be unrelated, but it is, I think, very closely related to our conversation today, the mass graves. Tell us about the mass graves that you discovered around the hospital. So, again, go back to January 2024 when Nasser Hospital was besieged by the Israeli military and they stormed the hospital and abducted a large number of staff, killed a large number of staff and patients. The hospital was taken out of action until around, I think, April May of 2024, when the WHO and Medical Aid for Palestinians went back into the hospital and started to clear it up and start to get it ready to function again. And where we stay as international doctors is on the third floor, sorry the fourth floor of the hospital. The floor very close to where the recent bombing happened, where the journalists were killed, that houses the theater complex, the intensive care complex, and also the bunker rooms where the international doctors stay. We have a balcony and that balcony overlooked what used to be a garden, I believe, and now is just a site of just flattened sand. And when the WHO and M.A.P. went back in to get the hospital back up and running they found that that area actually contained around 250-300 bodies. And it essentially was a mass grave where people with IV drips running were found bulldozed into the sand. So that was an area where people in tents were living and being treated. And during that siege, at some point, they had been attacked by military tanks and there were around 250-300 bodies. Who were obviously having received medical treatment, having external fixation on the legs, or IV cannulas, etc. How did the blockade and restrictions on aid deliveries affect the functioning of hospitals? And I know we've spoken about that, we've touched on that before. But I do want to lay emphasis on the fact that there was something abnormal happening, well it’s still happening at the moment where a lot of these medical supplies and medical equipment are not being delivered in Gaza and in surrounding areas? I'll try and frame it in a way as if it were a hospital stay, for example, in the UK or Australia or U.S. When you are a patient in a hospital you usually are given breakfast, lunch and dinner or any supplemental nutrition. In hospitals in Gaza, food was being supplied up until about June, May June, once a day for patients and staff by, I believe, either World Food Program or World Central Kitchen. We received the same food and that food would be rice, basic rice. And there might be a scattering of one or two chickpeas throughout it. And there was a hospital kitchen on site. And we didn't receive any bread because there was no flour. So we would receive a small package of rice towards the end of my month in July, the hospital was unable to serve food to any of the patients and staff. We were actually told to bring all of our food for one month. So all the medical delegations would bring in their own food, in their luggage. But the patients were then left to fend for themselves, rely on their family to feed them. And you've got to remember, these are people who are recovering from massive injuries, major surgeries, their nutritional requirements over and above what you would need just for normal, everyday functioning. So this would affect the patients. It would affect the staff. And when local staff were working at the hospital, they would generally stay for 24 hours on site. So unless they had any food to bring with them, if they didn't have any food, they wouldn't receive any food because the hospital was no longer able to provide food for them. So that's the situation with regards to food. With regards to supplies, some small amount of trucks with medical supplies were getting in. However, a lot of the trucks were bringing supplies that weren't relevant. For example, if I take you back to burns. Burns require specialized dressings, because the tissue has been damaged in a specific way. We ran out of these dressings towards the end of my month. When we started to run out of these dressings, we were able to improvise. Then we ran out of improvizations. So the dressings that we were dressing burns with were abrasive, they were painful, and they didn't contribute to wound healing. In fact, they probably were detrimental to wound healing. But we had to do something. All doctors that went were encouraged to donate blood. Blood was another thing that started to run out in short supply. And I would be dealing with one patient who may require around 7 to 8 units of blood. Typically, when people give a donation of blood, you give one unit. If you've got 50 mass casualties and they're all requiring that amount of blood to keep them alive, you can see how donations run out very quickly. When you donate blood, it requires a special set of equipment to process it correctly. It was being fast tracked in Gaza because the blood was needed quickly. So, for example, if you donate blood in the UK, US, Australia, it's screened for a lot of diseases, blood borne viruses, antibodies, because these can all cause reactions. There was minimal screening done because the pathology services had been taken out of action. Blood was required more than a screening was required. Again, it's a part of our practice that is not best practice, but we don't have a choice in Gaza. We either do something below practice or we don't anything at all. And this happens almost in every single clinical decision that you make. In terms of antibiotic use. I've touched on that some antibiotics came in, but they're not necessarily the correct antibiotics. One antibiotic doesn't cure all infections. And if you give the wrong antibiotic, you can cause harm even to the future population by creating antibiotic resistance. Another factor that isn't factored into, is medical equipment requires regular servicing in any other place. You would have your medical equipment serviced annually by registered contractors to do. To make sure it's working properly, that it's maintained and giving you the correct information that you need to keep someone safe. None of the medical equipment has been able to be serviced in Gaza for the last 22-23 months. So you've either got equipment that you've no idea whether it's giving you accurate information, but you have to use it or you've got equipment that just isn't working or you've got equipment that will consistently break. Again we have power surges and power cuts consistently again because of the blockade of diesel. They use solar power for electricity and they also have diesel generators as backup. I think we had about four or five days in July where there was a severe limitation of diesel available. And what that meant for the hospital was only critical areas received electricity and there would be some operating theaters, the intensive care unit, and maybe the critical area in the emergency department. Everywhere else the lights were off in all the wards, in all the other areas to conserve the fuel that we had. But the other aspect of electricity is electricity is used to power the water pumps. So during the middle of an operation, the water stopped flowing and a surgeon was in the middle of a surgical scrub to prep for an operation. And he literally said the water stopped as the same time as the air conditioning failed in the theaters. So we had to use IV fluid bags and squeeze them on his hands so he could finish his scrubber. That meant the toilets weren't functioning in the theater suite, and we were operating 15 hours a day. And of course if the water pumps weren't working in theaters, they were definitely weren't working on the wards. So nurses, how can you keep a patient clean if you don't have access to water? And this is a direct result of not having fuel, which is obviously something that's blockaded. The other thing is personnel. Now, we have seen an increase in denials for international doctors to enter Gaza. Everything is controlled by COGAT, which is essentially the part of the Israeli military, and they vet every single person that comes in and goes out to Gaza. So as medical personnel, we have to give our details way ahead of time to get pre-approval for entry to Gaza. You can't just walk in and say, hello, I'm a doctor, I'm coming to help. You have to be pre-approved and on a list. And that list is drawn up in conjunction with the Israeli military, the Ministry of Health, and with the WHO Emergency Coordination team. What types of doctors do we need? Which hospital is functioning? What's the particular need this week? Even then you don't know if you're actually going to enter until the night before where you have the final approval and denials have been up to 50%, 50 sometimes 75%. So delegations, one out of three may be allowed to go in. So that's also another part of the blockade. We had a point where when we left our delegation in July, we left at the end of July, there were no burns or plastic surgeons coming, but we needed people operated on continuously. But there were no surgeons coming in to do that. So, you know, we were absolutely terrified for the fate of our patients, especially those with huge horrific injuries that needed repeated operations, because there wasn't the personnel to do that for some time. So those people were essentially left to their own fate. And we know a number of people have died that would not have died had they received the appropriate treatment, we had the appropriate supplies and personnel. I do know that you mentioned there were three types of the main cases that you were presented with. First, injuries related to explosives, injuries related to gunshot wounds, and then you spoke about also the third one being road traffic related injuries and accidents. Now, of course, we've covered plentifully the issues you had within that environment, you worked at the hospital, at Nasser Hospital. But my question now is oriented towards famine, specifically starvation, forced starvation. Now, there are many denialists account that claim that Gazans and people within that environment are being supplied food by the Israeli forces. So I do want you to tell us more about what you witnessed regarding famine/forced starvation, specifically in that context. One of the first things I noticed in July compared to when I was there in October, just outside the Nasser medical complex, there used to be a market, market stalls, and it used to have big jars of pickle. There would be leafy green vegetables depending on what was available at the time. There may have been tomatoes or eggplant. The produce and food available for people to buy big jars of pickles. Somebody might be making something with flour. This time the market was not there. There was no market. It was just empty. The streets outside the hospital, just, maybe a broken table here or something there. So definitely visually, I saw way more food last time than I saw this time with my own eyes. My colleagues, I have a lot of colleagues, there's something about Gaza that when you go there, you immediately just inherit a whole new family and friends, whichever department or all sorts of people, you just develop these lifelong friendships. I noticed the change in my colleagues. A lot of them looked very different because of the amount of weight that they had lost. Very lean, very thin. Lots of hollows around the eyes, bones visible. But more harrowing were the children, a lot of our patients were children. Children can't run very fast. Children are one of the main casualties that we see, they can't defend themselves. Their bodies are small. Majority of the children that we saw had bones sticking out, ribs you could see. Bony prominence in their elbows. I was involved in a clinic with very small babies. A lot of them were very small for their age. I saw a 14 month old child that was about two and a half kilos. Normal birth weight baby is three kilos. This was a 14 month old child. A lot of the children I saw had no preexisting medical issues. So I know that a lot of the denialists are saying these children are sick anyway, even if you did have a medical condition, it doesn't mean that your ribs should be sticking out of your body. So, yes, I would say that there is starvation in Gaza. I witnessed it firsthand. I witnessed the lack of food. I myself had a lack of food. I think I lost about seven kilos there. And even though I took my own food. There is enforced starvation of a previously healthy population. There is enforced starvation of people who are sick and injured. I don't think that we should distinguish between whether you healthy or sick, if you're being starved, you're being starved and you can be starved whether you are an adult or a child. And I saw it in both. What do you wish the international medical community understood about Gaza that is often missing in reports? When we see the visuals of Gaza across mainstream media or wherever we see them, we see what comes across to us as a third world country. Look, people are in the sand, the rubble. People are desperate. They're thin, they are starving. The medical people of Gaza and the professional people are highly educated. Most nurses I met have got a masters in something else. Everybody speaks one if not two more languages. The standard of medical education and medical expertise is exceptional. I got sick the first time I was there in October and I received exceptional quality care. That they were able to give me with the resources that they had. They are up to date ahead of the game. Exceptionally interested in research and furthering their own education even during a genocide. You know, I'm part of a number of groups where I'm trying to further education within my field. I've just applied to the Palestinian Medical Council. I want to help with assisting the curriculum when it gets back online because there's such a thirst for knowledge. These people are incredibly intelligent, resilient, innovative. And this is across all sectors. If something happened, for example, to the telecommunication system within 24 hours, you had the most senior people working on it and telecommunications was back up and running. If there was any kind of civil infrastructure issue, there were people working as soon as possible. And as we saw, a lot of the heads of these civil infrastructure organizations have been killed, or have left the country. But there's this thirst to keep going and to keep building. There certainly was this thirst but I think that when you deny a population, when you dehumanize the population to the extent that the people of Gaza have been dehumanized, there comes a point where you actually are too tired and you don't have the energy to do that anymore. And this is the point that I think that we are reaching now. I had a question, if I could go ahead and pick up on the point regarding the medical professionals that are in Gaza today now in genocide and transitional justice studies, we often ask what rebuilding looks like in a post-conflict society. For medical professionals in Gaza, what kinds of questions will they be forced to ask in a post-conflict setting, whether that's about rebuilding hospitals, training staff, or dealing with trauma at such a scale? One of the first things that you mentioned here today was the medical community that was there. Whenever you first arrived, it was young. And what kind of problems will they be facing when there is a ceasefire that is prolonged or that the conflict comes to a close? What are the biggest issues that generation of medical professionals in Gaza will have to face? So, interestingly enough, medical education is continuing throughout all parts of health care, medical, nursing, allied health professionals. It's continuing on some level. There are a number of groups that are conducting online sessions trying to keep specialty training up by Zoom sessions. There’s a group called PAMA that is essentially taking cohorts of medical students and taking them through their curriculum as best that can be done. So to a point everything is trying to continue. The medical community and the educators in the community and, people from all around the world in the medical education community are trying to support the continuing development of medical education and training in Gaza. And this is occurring without the actual bricks of a university. So education will continue. I said to you the people of Gaza learning is like top of the list for them, whether it's the Quran, whether it's English, whether it's German, whether it's medicine, whether it's engineering, it's the top of the list. Which makes it so awful that school has been off since this whole conflict had started, but you will see little pockets of children in tents and somebody doing the alphabet with them. I think that medicine and medical education, nursing, nursing education in Gaza will continue because the people want it to. Where it remains to be seen, what Gaza is to really comment on how the medical community is going to rebuild itself. We have seen a number of countries like South Africa take cohorts of medical students into medical schools and continue their training and get them through. And actually, there was a cohort that graduated in South Africa fairly recently, did their finals. So there's hope there. There's hope but it all I guess will rely on people being able to return back to Gaza what rebuilding Gaza looks like. So what has this experience changed for you personally and professionally as a doctor? One of the really, really sort of, incredible things that I have seen is the lack of voice of medical associations and specialities around the world. Every single medical association should be standing on the street and calling this genocide out for what it is. You know, these are our colleagues. I see myself in so many them. I see my colleagues here in so many of them, whether it's ambulance drivers, midwives, physiotherapists, pharmacists, we all studied the same degree. We all have the same knowledge, We are all part of the same group, a professional group, and only very few medical colleges across the world have stood up and said that we have to take a stand against this publicly. Many of them are saying, we won't comment as a medical college, whether it's physicians or anesthetists or whatever, we won't really comment, we're going to stay neutral. But you can't stay neutral. Medicine isn't neutral. Medicine is political. So I'm amazed at the collective silence of the majority of the medical colleges, associations, etc.. And let's remember that one of the main codes of ethics regarding medical practice springs directly from what happened during Holocaust and by the medical practitioners then. Exactly right and as we know, during the Holocaust, many years later were revealed the details of the medical experiments that occurred and we shouldn't have to see that again. But we are going to see, we’re already seeing papers being published in the medical journals, about what's been happening in Gaza. We shouldn't have to see these medical experiments happen again. And that's essentially what's happening. It shouldn't be happening. We shouldn't have to read these papers. We're seeing injuries that have never been seen or documented before because weapons are being used that we've never seen injuries from. The types of gunshot injuries, if I come back to the gunshot injuries, we saw an increase of that during July. And the majority of these gunshot injuries were mass casualty events and they were happening at aid sites. And most people came in with one gunshot and it was usually targeted to a specific part of their body. And on different days, you'd see clusters of certain parts of the body targeted day, the majority head shots, another day, neck shots. We had one day of testicular shots in young men. And if you think about the people that go to these aid sites, they are people who have got energy, who have a bit of strength, who can walk kilometers of distance to this aid sites. These aid sites are set up few and far between. They have to stand in the sun for hours.

They usually get told to mobilize at 3: 52:51

00

or 4: 52:53

00 in the morning, stand when the sun comes out, stand in the heat. So these are young men, these aren't elderly people. I saw people coming in for mass casualty shootings from the age of about ten through to elderly. Majority were men from the gunshot sites. There was one day that was designated Women's Day, where women were encouraged to go to the sites. I believe this was a GHF site and I think, we definitely know that one person later was killed and we know that there were multiple injuries from shooting at the aid site on Women's Day. The types of bullets that were used were causing maximum tissue damage. So I have very many pictures of entry wounds, which are very small, but exit wounds with massive tissue damage. Often the limb wasn't salvageable, so that then led to amputation. So along with amputation from exposed injuries, you now have this cohort of injuries from amputation, from gunshot wounds and non salvageable limbs I think what you said earlier struck me very deeply when you said that all of you are facing very new situations because the weapons that are being used are also very different from what's been documented before. Is there something else that you'd like to tell us about how these weapons are different now and therefore make the treatment of the injuries harder than before. So I'll just bring this aspect into it. When you have a mass casualty incident, it's not like you bring a patient and you give the name the date of birth, you get a ticket, you go and get put into an area. You're literally just thrown onto the floor by whoever's carried you in. You're thrown onto the floor next to the next man who's been thrown onto the floor. There are people who are bringing these people in. They may be relatives. They may be friends. They may be associates. There are people everywhere. So it's not like you can go up to a patient's bed and go, this is Mr. Such and Such, he sustained his injury today and... It's not, you’re literally looking on the floor to see who looks like they're dead, who looks like they're dying, and there's nothing you can do for them because you don't know where you can find any IV fluids at the moment because the place is overrun by people and who looks like there's something you can actually do to help them. When a mass casualty comes in from an explosion or some kind of missile attack, very often you will see, especially on social media accounts, you will see everyone running in and pulling up people's tops and pulling their trousers down. And it all seems a little bit uncouth and botched. But they're doing that because they're looking for very small penetration sites of shrapnel. And when you see that, we'll try and do a quick ultrasound scan to see if there's any fluid in the tummy or fluid in the lung, fluid in the chest, if the patients clinically stable, and then we'll take them to the operating theater, even with the smallest wound, because the small entry site of the shrapnel and my colleagues came across a number of types of very sort of uniformly shaped shrapnel, almost cubed with smooth edges. It wasn't just a bit of metal or a bit of something from a building that had flown off in the explosion and penetrated someone. It looked like a cube with smooth sides. And we saw a number of these. And the small entry site caused maximum damage. So there was one 14 year old girl. The entry site of this wound was tiny. It was like, I don't know, as big as the tip of my finger, but inside it had literally macerated her intestines, it was mush inside and you couldn't tell that from outside. So very often when we look at social media, we see bodies lined up and they all look pristine from the outside. But these weapons, these thermobaric weapons, cause high intensity pressure injuries to the internal organs and the types of shrapnel or explosives weapons that they're using, which may have shrapnel within them are high velocity and designed to cause maximum damage internally as they traverse through the tissues. It means that, for example, if something like that enters your abdomen, there's nothing to salvage because everything is literally macerated and turned to mush, for want of a better term. Which is a horrific injury. The tonnage of explosives that they're using meant that sometimes we'd hear a bomb go off and we won't get called or we didn't get called because nobody survived. We had, from our balcony, we had a direct view of the morgue. So we'd hear a bomb go off, we'd wait. And after about 20 minutes, the dead would start arriving, straight to the morgue. And we would wait to get called. And like I say, sometimes we wouldn't. And that's because it was so devastating, the explosion that people were just vaporized. But we're talking about explosions around the tent camps of Al-Mawasi, the humanitarian area. And if you add into that a lot of the tents are nylon or canvas, so once the fire starts, it just roars through the whole area. You mentioned very briefly with correlation to the GHF sites. Now I'm wondering for the viewership that does not know what GHF is, it stands for the Gaza Humanitarian Foundation, coordinated with U.S. forces as well as Israeli forces. I'm wondering if could go ahead and help explain to our audience the frequency of the aid deliveries through GHF, while the time that you were there and with that frequency, how often were mass casualty events associated with these sites? So the aid site that we would receive casualties from and there were a number of field hospitals between the aid site and where we were. it was in the south. So just in the Rafah area, we were in Khan Younis area, which is just below the middle area of Gaza, and people would receive a text message telling them what time they had to be at the specific aid site and they would then travel from anywhere in Gaza if they wanted to take that risk to go to this site. And they'd usually get the call to move early in the early hours of the morning. So by the time that the gates were opened and that aid was put out for people to collect or, that's a very polite way of putting it. It was just a mad rush. There was no organization. And during this mad rush, the shootings happened. This is when the casualties, the shootings would occur and people would get injured. So it would tend to be around in the morning time that people would start to be brought in and they'd be brought in by car, cars are running on vegetable oil. They'd be brought in by donkey cart, they'd be brought in by people carrying them. And you would know where this shooting occurred and you would know that this was a GHF site or not, because there were other aid sites where also where shootings occurred because the people would tell you. Where did this occur? GHF. Or. Where did this occur? An alternative aid site. So people would tell us with their mouths where this occurred As I said, that the gunshots that we would see were in very strategic targeted places in the axilla. So in the armpit, there's a big artery there. We saw a number of gunshots up here because it can bleed out very quickly. You can also lose the use of your arm, if you get shot there. Into the groin, where you also have another major artery and you can bleed out very quickly or lose the use of your legs or sustain a groin injury. Into the neck, there's a number of gunshots into the neck. The head, I took many people for CT scans that had bullets to the head. There were people, generally children, we'd see have gunshots in the shin or they sustained gunshot injuries in the shin. And we were told that often it was gunfire just generally onto the ground. So you'd have ricocheting bullets. We would only really know when there was a GHF aid distribution when the casualties came in. We weren't sort of privy to that information beforehand. I'm sure we could have found out. But as I say they would usually have this information early hours in the morning. So nobody knew until they knew at that very that moment in time. If there was one story or one image that you could convey to the world after your experiences in Gaza, what would it be? I just have to think about one for a minute. That's So When I worked in the maternity unit and there’s a lot of pregnant women in Gaza. Having a baby is a time of joy. Should be a time of joy. It should be a time of celebration. And I remember every single new mother, whether she had other children or it was her first baby. Just had this blank look across their face. There was no joy, there was no emotion. There was nothing. And there was this newborn baby there. And we'd hear the bombs going off all the time. You would hear people in pain. And there would be a new mother with this blank look on her face. That, to me describes everything newborn life, there, a mother that is probably not going to be able to breastfeed her baby because she's malnourished herself. She has no hope. She doesn't see a future for her child. The despair, right now, in Gaza. That, to me, is everything. The despair for the destruction of hope for a new life. That's what I see in their eyes. Saira Hussain, thank you so much for this, for speaking to us. And I wish you the very best. I hope that there will be other volunteers in the near future who will do the good work that you've done for Gazans. Thank you. I hope that we move on to a state where we can help repair, rebuild, rehabilitate, give reparations to the people of Gaza. This has been Not to Forgive, but to Understand with our guest, Saira Hussain. For our listeners, don't forget to like, subscribe and stay tuned for more discussions.