Saira Hussain: Humanitarian Medical Practice in Gaza: Between Ethics, Anger, and Resilience

Despite the announcement of a ceasefire, conditions in Gaza remain unstable and violence continues to affect civilian life and medical care. Saira Hussain discusses her most recent medical mission to Nasser Hospital in Khan Younis, Gaza. Drawing on her experience working in a severely constrained healthcare system, she reflects on the conditions inside the hospital, the practical limits of medical care under blockade, and the ethical decisions clinicians face when equipment, medication, and evacuation options are restricted.

The conversation also addresses the psychological strain experienced by humanitarian medical teams, the challenges of speaking publicly about what they witness, and the broader questions this raises for humanitarian institutions, medical ethics, and international accountability.

Courtesy footage provided by Saira Hussain.

Watch our previous interview with Saira here: https://youtu.be/Qd0nS28iG3M

00:00:00 Introduction

00:05:21 Third Mission to Gaza: What Changed

00:10:07 How Repeated Missions Shape a Doctor

00:13:53 What Gazans Say vs Outside Narratives

00:16:48 Shared Grief Among Medical Teams

00:19:12 Patients vs Doctors: Emotional Differences

00:23:02 Short-Term vs Long-Term Medical Staff

00:24:26 Why It’s Impossible to Disconnect

00:25:27 Humanitarian Heroism

00:32:31 Medical Evacuations from Gaza

00:32:50 Hidden Trauma Among Medical Workers

00:36:02 Collective Anger Inside the Hospital

00:37:37 Neutrality and Ethics in War Medicine

00:42:07 Anger as a Catalyst for Advocacy

00:44:12 Survivor’s Guilt After Returning Home

00:46:44 A Shared Language of Humanitarian Grief

00:48:59 Risks of Speaking Out About Gaza

00:52:08 The Burden of Witnessing Trauma

00:54:55 Rethinking Humanitarian Institutions

00:58:51 Health of Doctors Working in Gaza

01:00:44 Returning to Gaza: Future Goals

Transcript

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While I was there, I looked after a 14 year old girl and Shahd Shehadeh, and she had a brain tumor and she was listed for evacuation in October 2025. She was on the critical evacuation W.H.O. list, which means there was a hospital waiting to receive her. She had a diagnosis. There were finances to provide everything for her to leave Gaza and have her procedure done. And the procedure was quite specific with a specific set of a equipment required, and it was all available. And at that time the tumor was relatively small. Now, I met her in the beginning of January, and during that time she had not been evacuated. The tumor had grown significantly, that she had become blind in one eye and was losing the sight in her other eye. The equipment that was recommended for this procedure was not available in Gaza. But if we did not do something to intervene with this brain tumor, she would start to have very severe symptoms such as seizures and would eventually die a very painful death. So, you know, there was a discussion and here we look at we look at the four principles of medical ethics. Okay, so autonomy. So there's a big discussion with the family and the patient. You know, you're going to die without this operation. You may die if we do this operation, you're definitely going to become blind. And this is a 14 year old girl and this 14 year old girl is in a room with her mother, her father and her siblings, all in one room and always present. And everyone always part of the discussion. And, you know, here we have to say that we think you should have this operation because this is in your best interest because if we do it, you have a chance. If we don't, the future is looking very bleak, painful and actually horrific for you and your family who will watch this happen. So then ensued a long discussion between the clinicians, local clinicians, myself, another the international clinician, about how we going to do this so that we cause the least harm possible and that we can get the best outcome for this patient. And, you know, if you do a score out of ten. A 10 out of 10 is the best way we can do it and 0 out of 10 is the worst that we could do. It would probably would probably be a 4. A 4 out of 10, was the best that we could do with what we had. And so you have to offer this option to the girl who was very, very intelligent, understood it, understood everything. And the family. And, you know, we also had to think, you know, if we do this and it is an operation that's very risky. We're going to occupy an intensive care bed probably for 7 to 10 days. Can we even justify doing the operation because of that? So these are the considerations we took in this particular case. We did the operation, with the families agreement, the young girl’s agreement, and she was in intensive care for seven days. She unfortunately died. So that's a case in action, if you like, of how we have to use medical ethical principles, and then how we think about moral injury, because the moral injury has a number of directions for us, should we have done it, should we not have done it? Should we have done it this way? Oh, but we couldn't. So should we have done it at all? But if we didn't do it, then she would die. And how many people didn't go to intensive care? Because we use that bed for her, even though we knew this may have a very poor outcome. Why was she not evacuated in October? That's the other thing. That's where the anger comes in. Many of the situations that we witnessed, in Gaza should not happen and it is very easy for them not to happen. And that's lifting the blockade, ending the occupation, making reparations, opening crossings for medical evacuations. And it's still in that situation now. Today we’re joined by Saira Hussain, an anesthetist who has worked at Nasser Hospital in Khan Younis through humanitarian deployments to Gaza. In this conversation, we discuss her most recent mission and what it means to practice medicine inside of Gaza, including the ethical dilemmas clinicians face when working with severe shortages, the trauma experienced by medical teams, and how witnessing mass suffering reshapes ideas of neutrality, responsibility, and advocacy in humanitarian medicine. Hi Saira, it’s very nice to have you back with us. We understand that you recently returned from your third mission to Gaza, including time at Nasser Hospital. Before we move into the deeper questions for this interview, could you tell us briefly what felt similar, different, and worse during this most recent trip? So I entered Gaza on the 6th of January 2026, some six months after my last visit there. And the main difference is there is this so-called ceasefire. And along with this notion of the ceasefire, there has been some changes in the strict and harsh restrictions that the Israeli blockade effected. So, for example, compared to six months ago, there was food in the markets. And when I say food, there was, as I was told, vegetables, fruit, eggs, frozen chicken, all coming from Israel, Israeli supplied. And these were commercial goods. These weren't aid goods. So these were coming in via commercial routes and being sold at quite elevated prices. The other difference was also in the markets were goods such as chocolate, chips, noodles, poor nutritional value food, but items that bring quick pleasure, dopamine release, etc., etc.. The other thing that was very readily available was cigarets and vape liquid, which was quite surprising and mobile phones and items of some high value clothing. I was quite shocked actually, to see such a change in the availability of products compared to six months ago when literally there was dust on a shelf and people were getting food from aid trucks, flour from aid trucks. So that was a very big sort of visual slap in the face, if you like, was the color in the markets, the availability of these items. The other major difference was on entry in Gaza, passing through the same route that I had six months ago was how few buildings were standing. In fact, and nothing standing. So there has been, especially in the southern area of Gaza, in Rafah, huge demolitions. And there was just piles of huge mountains of rubble, almost like somebody taken a huge sweeping brush and just swept up the remains of buildings and again, on the same route on my exit, I saw detonations of buildings. So this sort of a systematic detonation of any remaining structures appearing to level the southern area of Gaza in Rafah. Which is where the borders has just so-called meant to have just been opened. The other very striking thing compared to six months ago was the contraction of the area of where people were living and existing. So since my time, six months ago, there had been various evacuation orders and notices of people to move into a very constricted area. So they've been moved from the south and the north and the east and pushed very close to the water. So everybody's trying to exist in a very small space in the same kind of tents or camps that they had been in six months ago. So no new equipment to make new tents or encampments has been allowed in. So these were like shantytowns and thin pieces of canvas fabric, children everywhere. And, you know, lots of roads don't exist. They're just sort of puddles of mud and sand. There'd been some heavy rainfall as well. So the area was very crowded, very constricted. There was a, you know, this supply of almost considered luxury goods in the markets. And a lot of trucks coming and going, but very few aid trucks moving, more commercial trucks. With regards to the hospital. The hospital has again now serving a greater number of people because those people have been contracted down into that small area where they're living. So you've got an even greater burden on the limited amount of beds and services that the hospital, Nasser Hospital, where I was at, can supply. You’ve now experienced Gaza across multiple missions. How does the accumulation of these experiences shape your work as a clinician and as a human being? So I think we just have to acknowledge that the situation of Gaza is a unique situation and one that's never been faced by the humanitarian and modern humanitarian sector, in that there is a complete blockade by an occupational force and a complete restriction on movement of people away from a situation which is no good for them. And so they're essentially trapped and trapped in a box that has ever decreasing supplies or supplies that aren't fulfilling their needs. With no sort of clear end in sight. And so because this isn’t my first visit, and I do intend to go again. For me, it's an ongoing project, so each visit provides me with a different set of input in how I work when I'm in Gaza. And so the first time, for example, when I went, I went with no expectations. I had never been before. I knew that I was going to be working in a resource poor environment. I knew that I was going to be working in an active war zone. I didn't know the people. I didn't understand the system I had not experienced the volume of injuries and the type of injuries that would happen in very quick succession and also, you know, was subjected to a huge number of people suffering from chronic illness, a chronic disease that had no option of getting better. And the second time I went, I was in a different condition again, because there was the Gaza Humanitarian Foundation and the shootings and all of the famine that was declared at the time, which brought a new set of circumstances. There were multiple evacuations of people and areas. And we were, you know, ourselves surrounded by military at that time, which again brought another new set of circumstances for medical staff on the ground. And this time I have gone in the so-called ceasefire, which I just want to explain. As of today, bombs are still dropping every day, multiple times, day and night. There are still quadcopters firing on civilians, There are still snipers shooting civilians. And I know this because I treat the people who are wounded by these mechanisms of the occupation and there is still malnutrition despite the fact that food is now available because the prices are high and the products are nutritionally poor. In terms of my work, I'm now very familiar with the hospital. I'm very familiar with people in the departments. So I have an understanding, a better understanding than a first timer going there, of how things work. And I know what to expect. I can adapt my practice. However, my practice as a doctor in Gaza falls short on a number of aspects and doesn't come anywhere near my practice of doctor in Australia. And I know that's true for a number of my colleagues and the reason is because of the lack of supplies, the restrictions on our movement, the restrictions on the movement of people with severe and chronic illness, and also the restrictions on the equipment that we can bring in as individuals and as groups. I'd like to ask about the difference between what is said about Gaza in places like the United States and what people are actually seeing on the ground. From your experience speaking directly with people there, including in Arabic, you mentioned that you picked up a few words before going on these three missions. What did you hear from patients and civilians about what is happening? So I have been mildly active in our activist groups here in Australia. So I listen to the conversations and demonstrations for people who are outside of Gaza and also talk to the people inside. And the way I describe it is like this when I'm inside Gaza, it's like I'm inside a fishbowl and you have all the other countries and activist groups and people with conversations looking in and it's like two parallel universes. Because when I sit and drink tea with my colleagues and my friends in Gaza, our talk isn't about politics. Our talk isn't about leaders are talk isn't about occupation. Our talk isn't about 1948. Our talk is about and I hope I can get out one day so that my children can lead a better life. Or I hope this war will end soon so that we can start getting medical supplies in. You know, very rarely have I been in a conversation where we're talking about Hamas or Fatah, which is the other party, because I think this is also really important to remember and again, it's a line that people like to use of Hamas, Hamas, Hamas. Hamas is the elected government in Gaza. So they are responsible for everything, for health care, for sanitation, for agriculture, etc., etc., etc.. But unfortunately, the people view Hamas as the armed group, the terrorist group, the guys with guns in mosques and bandanas, but they're actually an elected ruling party of Gaza. So I think, whenever Israel starts to feel victimized, it throws it back on Hamas. What we have to remember is the situation in that is active in Gaza right now is directly because of Israel. So it makes no sense. The situation would not be the situation is now were it not for the actions of Israel. And I'm not talking about October the 7th. I'm talking before when they had the calorie restriction, when they limited agricultural supplies, etc., you know, limiting the access of people to get chemotherapy, radiotherapy, the restrictions on people working in Jerusalem, etc.. So really the only blame lies with Israel and its actions because this is what it has produced. Can you describe moments when you felt your own grief reflected in the faces or actions of your colleagues—other doctors, nurses, or aid workers—and how that shared emotional terrain affected your ability to continue your work? So this is an interesting question because I don't think that there's actually time for grief when you’re in Gaza. Because in Gaza, the situation is, you don't look to the future when you're on the ground in Gaza, whether you live there, whether it's where you were born, whether you are visiting as a humanitarian or logistician or whatever, you are actually very much living in the moment when you’re in Gaza because there is no you cannot predict what will happen next. Well, maybe if you look at the stages of grief, I think that there’s a sticking point in one of the stages of grief. And I think that's anger. And I think that's persistent and that persists among many people. Because if you look at people who have lost their relatives, for example, they come in and they can't be saved or they have an operation which is unsuccessful or they lose a child or the whole family is buried under rubble. And we see this on social media. We see anger, we see anger. And that anger persists. And the other stage of grief that we see is depression. And myself, if I'm in a stage of grief, I'm still at the anger stage because, again, as I say, to me, Gaza is a ongoing project. And, you know, my anger is aimed at, again, the people that are responsible for producing the situation that I see, my friends, colleagues, the population in. And so in terms of grief, when we kind of think of something where you become upset or have feelings of sadness and despair, I think that they are yet to come because I think when you give in to grief, you are getting into that acceptance stage. And right now, I don't think anybody wants to accept that this is how Gaza is going to end, regardless of what we're seeing. Earlier you spoke about the patients you encountered and the emotions they carried. Did you notice any differences between how patients experienced the situation and how your colleagues experienced it, whether those colleagues were local staff or international aid workers? So with my international colleagues, they come for a short period of time. It can be as short as two weeks. It can be is almost six weeks. A very few people stay for a bit longer time and the people that come for very short periods of time, it's a whirlwind. There's so much visual stimulation and noise and situational perspectives that they weren't expecting and have never come across before. And often that would be met with anger. You know, they'd come back from working in the intensive care unit or the pediatric ward, and it would have been an intense shift. And usually, we'd have a balcony where we'd go and hang out,

and that's when people would just be like: 20:07

How is this possible? Why is this continuing? How dare they? How dare the Israelis let this persist? Why would they not let the patients out? It was more anger. And with my local colleagues, again, actually, a lot of the medical staff are pretty much accepting of the situation that they're in because they don't have a choice. Anger gets them nowhere. They just have to accept day by day. Today, we have antibiotics we won't worry about tomorrow. And then tomorrow comes. And tomorrow, yes, we've got antibiotics. We're not going to celebrate. We’re not going to have a party, we're not going to say, this is great we're getting antibiotics. We don’t make any assumptions. And you know, when when you are there as an individual and it's difficult to ground yourself because you are living in time bites, you know, for example, you might do a shift. And for example, if I'm in an operating theater and I'm in an operation, I know that this operation is going to go through these stages. We're going to start, the operation is going to proceed, then maybe one or two issues that need to be sorted and the operation is going to finish and we're going to move to the next one. And with our privilege that we have here, our equipment, everything and all the stuff that we have and available to us, things pretty much go smoothly. There the same process will be met multiple times with unexpected things, such as the electricity may suddenly fail, the generators will go off, suddenly a mass casualty will come through the door. So you can't even sort of accept the normal timeline of medical practice that you would have elsewhere. So you're always switched on. So you have very little time to ground yourself and to reflect and to think because you have to be ready for anything at any time. So again, if you're there for a brief period of time for two weeks, I think the main overwhelming emotion that you see is anger. And because people can't understand how this is happening, and I say my colleagues who are now living through this for longer than this particular part of the genocide, they're used to having limited electricity. They're used to having restrictions on what medicines come, just not to the extent that they have now. But, again, you know, when they when everybody heard the news of the ceasefire in October, there wasn't a great big party. There wasn't a great big expectation of our lives are going to get better because they'd only learned from before that these words often do not play out and they often mean nothing. So it's best not to expect because the hopes have been dashed before and this is going back tens and tens of years. Related to that, did you observe differences between medical staff who live and work there long-term and international workers who may only be present for a short mission? How does that difference in duration shape the way people emotionally process what they are witnessing? No, I think that it's such an overwhelm for a practitioner from outside and every sense is assaulted in Gaza. So even if you're there for two weeks as opposed to six weeks or eight weeks and you're all your senses are activated the whole time and there's no chance to disconnect. And very often you're staying with 15 or 20 people. There's noise all the time. There's interactions all the time. You will all eat together. People pray together so you can't disconnect even if you try to disconnect, you actually can't. Even if you put noise canceling headphones on and somebody will come and get you, the bomb will be so loud, it will get through your headphones. I was thinking about how impossible it was to try and even read a book because you would read half a paragraph and something would happen to take you away from that. Even if you try to actively disconnect, it's impossible that it's actually impossible to disconnect in Gaza. When you say that something would take you away from it, do you mean that you needed to attend to another patient or that an event would happen that required your attention elsewhere? It may be somebody, one of the doctors coming to find. So the international doctors will come stay in an area together. So if for example, somebody wanted to come and find me because they wanted me to help them with something or somebody needed to ask me where somebody else was or somebody else wanted to ask me, was the hot water functioning in the room? Or somebody wanted to come and say, Would you like to eat now? There's a constant interruption, not always unwelcome interruption, but you know, there is no downtime. And I think that's why, ironically, paradoxically, a lot of people say the same thing. I have never slept as well as I do in Gaza, because when you close your eyes to sleep, your brain is like, I've got to take this chance to sleep and you sleep before you're usually woken up by bombs just before the first call to prayer in the morning. That's usually when that happens. Humanitarian work is often described in heroic terms. From your perspective inside the experience, how do grief, helplessness, or moral injury complicate that narrative? And so this is an interesting and really interesting aspect. And that is looking at humanitarian workers in Gaza. And I think that this, again, is now become a totally unique situation and simply because traditionally humanitarian work has been very structured and organized and funded and often comes from another wealthy country, applying their principles and adapting them to local, local availability of guards, personnel, etc.. In Gaza, there are a couple of organizations soon not to be in there, such as MSF, UK Med, Oxfam, UNICEF, which have been able to act in this manner. The majority of medical staff have come as almost independent humanitarian organizations, not bringing too much with them, but just bringing themselves maybe the little equipment that they're organizations can bring. And also it's been very difficult to get personnel into Gaza so you have a wide range of people and I think a wide range of people with very differing reasons for wanting to come to Gaza And I think that the underlying reason for their reason to come to Gaza shapes how they deal with moral injury and shapes the stage of grief they get to. And so, for example, for me personally, when I think about moral injury, for me having seen this now the third time and I've seen no change, in fact, I've seen a deterioration in all aspects of life; mental health, physical health, financial health. And, you know, just the basic provisions of life are completely obliterated with no immediate or any sort of future prospect of recovering any of that in the near future. I feel, you know, I feel a loss of faith in those organizations that were set up to prevent this and a loss of faith in the leaders that are meant to organize the organizations to prevent these recoveries, make this better. And I feel very angry about it because I know that the situation could be very different if a different path was taken. For example, if I can give you a kind of example of a patient While I was there, I looked after a 14 year old girl and Shahd Shehadeh, and she had a brain tumor and she was listed for evacuation in October 2025. She was on the critical evacuation W.H.O. list, which means there was a hospital waiting to receive her. She had a diagnosis. There were finances to provide everything for her to leave Gaza and have her procedure done. And the procedure was quite specific with a specific set of a equipment required, and it was all available. And at that time the tumor was relatively small. Now, I met her in the beginning of January, and during that time she had not been evacuated. The tumor had grown significantly, that she had become blind in one eye and was losing the sight in her other eye. The equipment that was recommended for this procedure was not available in Gaza. But if we did not do something to intervene with this brain tumor, she would start to have very severe symptoms such as seizures and would eventually die a very painful death. So, you know, there was a discussion and here we look at we look at the four principles of medical ethics. Okay, so autonomy. So there's a big discussion with the family and the patient. You know, you're going to die without this operation. You may die if we do this operation, you're definitely going to become blind. And this is a 14 year old girl and this 14 year old girl is in a room with her mother, her father and her siblings, all in one room and always present. And everyone always part of the discussion. And, you know, here we have to say that we think you should have this operation because this is in your best interest because if we do it, you have a chance. If we don't, the future is looking very bleak, painful and actually horrific for you and your family who will watch this happen. So then ensued a long discussion between the clinicians, local clinicians, myself, another the international clinician, about how we going to do this so that we cause the least harm possible and that we can get the best outcome for this patient. And, you know, if you do a score out of ten. A 10 out of 10 is the best way we can do it and 0 out of 10 is the worst that we could do. It would probably would probably be a 4. A 4 out of 10, was the best that we could do with what we had. And so you have to offer this option to the girl who was very, very intelligent, understood it, understood everything. And the family. And, you know, we also had to think, you know, if we do this and it is an operation that's very risky. We're going to occupy an intensive care bed probably for 7 to 10 days. Can we even justify doing the operation because of that? So these are the considerations we took in this particular case. We did the operation, with the families agreement, the young girl’s agreement, and she was in intensive care for seven days. She unfortunately died. So that's a case in action, if you like, of how we have to use medical ethical principles, and then how we think about moral injury, because the moral injury has a number of directions for us, should we have done it, should we not have done it? Should we have done it this way? Oh, but we couldn't. So should we have done it at all? But if we didn't do it, then she would die. And how many people didn't go to intensive care? Because we use that bed for her, even though we knew this may have a very poor outcome. Why was she not evacuated in October? That's the other thing. That's where the anger comes in. Many of the situations that we witnessed, in Gaza should not happen and it is very easy for them not to happen. And that's lifting the blockade, ending the occupation, making reparations, opening crossings for medical evacuations. And it's still in that situation now. If an evacuation had been possible, where would that patient have been taken, and what options realistically exist for patients needing treatment beyond Gaza? The usual evacuation countries are Egypt or Jordan and sometimes Europe, Romania, or Italy. In Gaza, what forms of trauma do medical professionals experience that are rarely acknowledged in humanitarian discourse, particularly the kinds of trauma that remain after they return home? I think the thing that's really different in Gaza is the violence of everything at every level. So not just the violence of the military attacks, but the the aggressiveness and violence of things like tumors, because there are no medications or drugs to slow things down. So things happen very dramatically and violently. And everyone you work with has lost someone in a violent way, whether it's a building collapsed on top of them, whether it's being shot while going to find food, whether it's a child being run over in the street. You know, there's multiple there's so many children on the streets in Gaza and there are a lot of big trucks and the amount of road traffic injuries and little kids, you don't see little kids running around and there's no adult with them. Because the tent encampment stretched for miles past where the road is. So, you know, and there's no schools so, of course, there are going to be children everywhere. You see violence in the animals because you've got a donkey to try and transport your goods or belongings or you're trying to sell water or you're trying to make money by using it as a taxi. The animals are whipped and they've got, sores on them. For example, there's a mattresses on a hospital bed. So people when you move somebody who has had a very painful operation who was in intensive care, you’re moving them on to something that is painful them. There was no mattress, it's just a wire frame. There are no pillows and sedation is withheld often because it has to be rationed. So you have children who have breathing tubes in their mouth, this really down their throat, in their nose and they’re awake. So it's the violence of it that people don't see. And there's nothing that can be done to change that because people are acting in the best way that they can with what they have. So for example, the hospital security has to deal with ingressions of people who shouldn't be there and very often that may be in a violent way, especially somebody stealing from the hospital or stealing from doctors or nurses. People's mental health is deteriorated. So children are punished more severely than would otherwise be, we had a very sad case of a child that sustained a head injury, six year old child, after he'd been beaten by a family member. And that's because there’s a mental health crisis that is affecting everybody, there. So the violence in every aspect, I think is the unspoken trauma. Earlier you mentioned that there was often no time to process grief because everyone was operating in a state of constant vigilance. If grief could not always surface in the moment, did you notice other emotions—such as anger—being experienced collectively among medical teams? It was the one space where you could actually be free with your words and the way you spoke and how you spoke. People who would not usually use profanities would swear, you know, and they'd say, I'm sorry for my words. And we'd be like, this is the one place you are allowed to express yourself because we all understand this. And it was a place where men, women, whatever your specialty, nurse, doctor, whatever. Even you know, with local colleagues, we were allowed to be angry together about the situation we just witnessed or the general situation or particular situation. And you could express it in a way where you weren't going to be called out on your affiliation or you weren't going to be called anti-Semitic and you weren't going to be called. But what about October the Seventh so you could express your anger honestly about the situation that you had witnessed because you had seen it with your own eyes and somebody else had seen it with you. So it was a safe space to talk about anger. Most people will stay in contact and will still keep those safe spaces for sharing grief. After repeated exposure to violence, loss, and extreme conditions, how does that reshape one’s understanding of neutrality, professionalism, or ethical obligation in humanitarian medicine? I think professionalism comes from within and one cultivates their own manner of professionalism. So I think that you, as an individual, hold your values, even though you have to suspend them when you're in a situation like Gaza. It doesn't mean that because I did something in Gaza, I'm going to change my professional attitude towards it when I'm practicing in Australia. And I think the same of the my colleagues in Gaza, they will try and uphold professionalism as much as they can within the constraints that they have. I'm very humbled to work with my colleagues in Gaza. I don't know know how they turn up day by day and do the great job that they're doing. So ethics, I think that medical ethics and there's a vacuum at the moment of the four pillars of medical ethics in Gaza, because they're not possible. And so autonomy, I mean, there are a number of organizations working in the background and even, you know, us guys on the ground don't know what their directions are. For example, they might be concentrating on limb reconstruction or they might be concentrating on sexual and reproductive health or they might be concentrating on, young men committing suicide. But again, a lot of things are being done to the people of Gaza because that's what other people often from the outside are deciding. So when we talk about autonomy and patients can have autonomy to a point, but it's like, well, we can take your child out for surgery, but we can only take the mother and we can only go to Egypt. And if somebody says, But I don't want to go to Egypt, I knew there's a better surgeon in Jordan or I'd rather stay. Very often that autonomy is taken away from the patient or the patient's relatives or the caregiver. If we try and act in the patient's best interests, it's again, if we acted in the best interests of our patients, we would be opening the borders and using all the medications that we know are available in Gaza before and should be available now. But sometimes you can't act in the patient's best interest because you don't have the tools to do that. So that's where the moral injury comes in. As a health professional. For example, people who have abdominal injuries often are left with an abdomen where they can't fully do the procedure because the bowel is too fragile. So they have to wait for some time for healing before they finish the procedure. Because some surgeons have been denied and some surgeons are allowed in, they've just been saying so okay that surgeons here now. So we're going to do the procedure anyway because he might they might not be another one for the next two or four weeks. And the outcomes have been bad. So you have to ask who's interested are we acting in. It's not the patient's best interest because you know, we shouldn't be doing that procedure at that time. So there's an element of desperation there. And again, an element of we’re damned if we do and damned if we don't. Yeah. And as a result of that, harm is caused. For example, again, if we don't have the proper routes of cleaning medical equipment, it may not be sanitized into the highest levels that we expect, but if we have not nothing else to use. So we either have to use these methods which aren't the best methods for cleaning something and potentially put another patient at risk of infection or we don't do it. You know, I have a test that I ask myself and I teach my trainees. I'm like, when we're discussing a case about ethics, I say, would you do this for your mother, your brother, your father, your sister, or would you treat your? And if they would say no, the I say, well then you shouldn't treat your patient this way. And we can't use that test in Gaza because nothing would happen. Can you speak about moments when emotions like anger or grief became a source of propulsion rather than paralysis—pushing you or your colleagues toward advocacy, testimony, or critique? Most definitely. The time when you can sit with this, when you come home, when you come out with the environment, and that's when you can start to say, “Well I've been there, this is what I saw, I need to tell you, and I need to make you angry about it.” Because anger is what pushes the change, not, you know, not complicity, not passivity. Anger is what makes the change. And I see often when people come out of Gaza, they're often, medical professionals, are often the first one on the podium at protests talking passionately about this because they're angry and there's also an element of guilt. We all experience the survivor's guilt of leaving because it's unfinished business. It's still ongoing and evolving in a way that none of us want, which also is a catalyst for anger. But, you know, this is this is my third visit, and I can't believe that I'm still hanging my head saying how is this allowed to continue? I said this each time. I've been hoping that the next time that I go, it will be a completely different environment and each time it’s worse. And that also makes you angry. But that also comes the problem of somedays it's like, what can I do? What more can I do? I put my feet on the ground, I put my hands in the blood. I've stood on a podium, I've been on the TV, I've spoken to politicians, I've, you know, spoken out in my workplace. I've done all the things that potentially put myself at risk to be an advocate. But as we see, advocacy has its hands tied right now. Building on what happens with this survivors guilt, what happens when humanitarians return home? Carrying that trauma that you were speaking about that is not socially legible or publicly acknowledged, like you just said, the costs of speaking out. How does that silence personal or political compound that trauma? So one way that you can manage this is by continuing to work outside of Gaza. For example, I'm still involved in trying to help with medical evacuations. I still am involved with teaching, I still psychologically support my friends there. And a lot of people, especially people who've been there for a while and made connections and understand the systems can try and keep influencing things and that keeps you connected to that situation. Again, I think the longer that you stay there, the more connected to the situation that you feel. And most people say, yeah, I'll be going back again. Very few say they're not going back again and have an intention to do it, but to keep making change for people actually on the ground, that is what helps you manage the survivor's guilt. For example, there was a child, a six year old child, when I was there and everybody was throwing up their hands saying this child was meant to be evacuated today, the evacuation didn't take place. We're not sure why. So on my return, various groups I'm involved in, managed to speak to a pediatrician who had been there a few months ago, who knew a route where we could get the child evacuated. I knew a surgeon that was on the ground from another organization and saw the child, spoke to the head of pediatrics and put in an evacuation order. So these little wins that you can do that helps you feel that you haven't abandoned the people there. So it mitigates guilt a little bit. Not everybody does this. A lot of people do, and they continue to work. I know a lot of people in the US will you know, they will have a political stance and rally at Capitol Hill. There's a big group that do that quite regularly or they may move into politics or try to get into the political sphere, but most people can't leave it. And I think that's how you manage your survivor's guilt one way or the other. With that international shared perspective between professionals, do you see a shared language of grief developing among human rights advocates across borders and medical professionals who work in conflict and conflict zones, even across different regions and crises? Of course, you have not just only worked in Gaza and worked in other locations as well. And I think we hear this quite a lot. You come across people who've also worked in very different places like Sudan or in natural disaster areas. And the major difference is that again, Gaza is the unique situation in that you are one of very few people allowed into a kill box. There is nothing allowed in, everything is controlled and we are the very privileged few that actually get our feet on the ground. The medical community is one of the very few communities that are consistently allowed in, even though there are many denials and we hear, I've been to Sudan, I've been to Afghanistan, and I have never experienced what I have experienced in Gaza. And we hear that a lot. Because people are allowed to evacuate, people have somewhere to flee. People are allowed to flee, supplies are allowed in. I know the situation in Sudan is a little bit precarious, and you have consistent humanitarian organizations on the ground and organizations that are acting with impartiality, neutrality. We have the situation with MSF at the moment where they are being accused of complicity because they are now saying that not the hospital is a site for Hamas actions with no nothing to corroborate this fact, making the hospital a target. I mean, again, a shared humanitarian response to this is is shaking our faith in an organization that is so well known, so trusted. And to speak with such disastrous, reckless language really makes you question what's happening with the whole of the humanitarian sector right now. When we spoke earlier about your most recent mission, you mentioned the personal and professional risks that can come with speaking publicly about what you witnessed. Could you elaborate on the ethical tensions humanitarian workers face when deciding whether and how to speak out? So this is an interesting question. I speak very freely about Gaza in my workplace and outside of my workplace. Because I feel I have a right to because I've been there. And I think my situation is very different from someone who is giving an opinion or discussing something they read in the news or wanting to talk about the issues. But I do know that it's not spoken about very much in my workplace and this is mainly due to ignorance. People are still very ignorant about what's happening, you know, in that part of the world. It doesn't apply to them. It applied to them briefly when we had Herzog on Australian soil because suddenly people realized that$5 million of their taxpayer money went for some protests because people became violent and they sort of thought, well, why? And then they looked into it and but unfortunately that gave rise to a lot of anti-Palestinian rhetoric again. So I know in different countries there are doctors are doxed, there are nurses that are doxed and headhunted and witch hunted for speaking out about Gaza. I also know that one of my colleagues who was in Gaza with me, he speaks out very regularly and has been arrested a number of times. But we all feel the same way. And those that do speak out is that the risk of us speaking out is less than the risk of people passing this situation by people say to me, but if you talk out, you might not be allowed to go back there again. And I'm like, that's okay, someone else can do my job there. But what they can't do is say what they saw. So I have to say what I saw. And if that means I don't get in again, so be it. Someone else can do what my hands can do, but they can't see what my I saw unless they go. So and a lot of people who do speak out feel that way. There are a number of people who who don't feel that they can. And a couple of my colleagues do have very toxic workplaces with quite vocal people who are Zionists and have publicly said so. And you have to weigh up the balance of, you know, I need to pay for my children to be educated and pay for my mortgage. I have got to be very careful about what I say. So far I’m very fortunate in that I haven't had any of these issues. That's not to say that I won't. But I will always maintain that you can't take away what I saw. You can't take away what I've written in my diaries. You can't take away the pictures that I've got on my phone. And that's my defense. If anybody accuses me of anything. And as I always say, I'm not anti-Israel anti this. I am anti-genocide this is my perspective. More broadly, what ethical tensions arise when the act of witnessing and speaking about trauma becomes part of a humanitarian’s responsibility, yet doing so can reopen personal wounds? Well, this is also a very interesting perspective because as I read somewhere, you know, we've had more than two years of scrolling through pictures of dead babies and exploded limbs and houses falling on people. Now the Epstein Files and we're becoming desensitized to these images of trauma and violence. So we are becoming desensitized to the imagery of it. I think that means we should speak about it even more, especially people who have witnessed it. To remind everybody that these things are important to know this isn't normalized. This is not normal. And, you know, I can show you pictures of blood on my hands. I can tell you how I felt when someone died in front of us when we couldn't save them. I think that speaking about physical trauma is very important. I think about speaking about the mental trauma that these people are facing is also very important. And you know what arises with that is some very uncomfortable truths and those uncomfortable truths are that the people that live in Gaza, the society of Gaza is like any other society. There are good people and there are bad people. Good things happen and bad things happen. There is domestic violence, there is sexual abuse, there is pedophilia. There's all the things just like any society. And those things also give rise to mental trauma, physical trauma. And it's important to also talk about those things. It's important to talk about rape. It's important to talk about incest. These things happen just like they do in any society. It's important to do that because everybody needs to know that Gaza is a normal society. It's not people with tattered clothes running around in tents. These people had cars, jobs, houses. They had incest, they had rape, they had all of the things, they had everything that every other society has, good and bad. And that's you know, people might think that's a traumatic thing to talk about. I've seen sexual violence, I've seen domestic violence, when I’m there, I've witnessed people being beaten. Because they act like any other society does, good and bad. 50% of people were living below the poverty line before all of this. Now you have engineers, doctorsm lawyers, ministers, all living in tatters, in tents, in rags. These mental health issues obviously are going to be amplified, but it doesn't mean they didn't exist before because that's a part of normal society. Yeah. Looking forward, how should academic journals, humanitarian organizations, and civil society better account for grief, trauma, and emotional strain in humanitarian work—not as individual weakness, but as forces that shape the work itself? So unfortunately again, the situation of Gaza has probably highlighted, this is not new, but it's probably highlighted, this idea of white saviorism, trauma tourism, getting the badge because I've been to Gaza and but what is not accounted for is the trauma and the grief and the mental and the moral injury that you come away with. So it's like, you know, you don't get PTSD from being in Gaza because the situation hasn't finished. You know what I mean? You can't. You’re ongoing, it's living because the situation is still the same it's not like there was an earthquake and there's a big clean up and everybody who's had broken limbs or all the bodies are accounted for. Everybody has had their operations and then we start again. Nothing has finished. Everything is still evolving, which is what makes the situation so unique. I mean, Sudan is probably the same. You couldn't quite the same with Sudan. But these situations where you have an ongoing deterioration in the situation. It’s not even stable, an ongoing stable bad situation, it’s a deterioration with no end in sight. In fact, every day brings a new dimension of where things may get even worse. So I think that one of the things that humanitarian organizations really need to do is to really get in to the system that they're trying to assist. For example, many humanitarian organizations quite rightly employ local staff to perform clinical duties. So, for example, MSF and a lot of their people are administration logistics, logisticians, but in hospitals are local staff who are paid by MSF or UK Med or UNICEF. So the people that live there, born there, that work there, and they are contracted to the humanitarian organization. But doing that removes them then from seeing with their own eyes and living and walking the walk that the local community are doing. And then they don't see or feel or share the same moral injury, the same anger, the same struggles that the people are facing on the ground. So, you know, there is a difference of being an admin in a humanitarian organization, which a lot of people are, and a lot of people on a convoy bus, are they are people who are filling in spreadsheets and doing ordering and stocktaking and needs assessments and are not actually walking the walk that the people in Gaza are walking. And I think there needs to be more than that. And we as the emergency medical teams, we actually do walk with them. We hold their hands and we do it, which gives us a better perspective. But our numbers are small compared to the bigger organizations. So I think that needs to be taken into account. And I remember saying to someone, what we need to do is work with the people. They have everything they need to succeed, but we need to work with them and not gift wrap pity for them. They don't need our pity. They actually don't even want our help. They like, just leave us alone, give us tools and we'll do this all ourselves, just like we have done before. But there's very much an idea of doing things to Gaza, not doing things with them, or giving the tools to let them do it themselves the way that they know they can do it. And this is why I think. Before we conclude, I’d like to return briefly to the wellbeing of the medical humanitarian workers who were with you. Do you have any reflections or anecdotes about how those colleagues were coping physically and psychologically while working under such conditions? So we're strongly encouraged to take all of the medical supplies that we may feel that we might need because of the scarcity or rarity, or they may not be available for us to get in Gaza. So and almost everybody during my time in January contracted a respiratory illness. We all had a sore throat, a cough, very similar to the COVID type symptoms that you get, 24 hours of a fever. I myself again had to have some I.V. fluids and my surgical colleague from the states, she had two days in bed, where she was very well. But regardless what might lay you up in bed for about a week at home, because your time is limited in Gaza, the minute that you can stand up and you can function, you're back working because your time is limited and you want to do what you can. But yes, people often get sick because the water supply is filled with water, but the filter hasn't been changed for over two years. Food is available. But again, meat was available. But as I remarked to my colleague when we saw it in the market, the chickens were huge with no idea if they were full of antibiotics, you were full of all the things that we would never eat. Usually, we don't know. These were frozen chicken was not in packaging. There were huge. They looked abnormally large and we've no idea if there were pesticides. Everybody got a bad tummy at least once, even if you were meticulous with hygiene. And one of my colleagues got very, very ill, as we talked about and still remains ill, but steadfast that she's going to improve. Yeah. I have one last question for you, Saira. You mentioned that you plan to return there. What is it that you hope to achieve during your next mission? So some of the positive aspects of the humanitarian work that's going on, on the ground is, for example, there's a huge number of amputees, there's a huge number of people who have unresolved fractures or injuries and that require specialist intervention. And so this has been identified is that we can't just willy nilly send in one time a neurosurgeon, one time a orthopedic surgeon, one time this type of doctor. We have to identify where we can really get to work with the equipment that's available. The local staff that are there. We work together with them. And so one of the aspects that we're looking at is limb reconstruction, because that gets people functional again. You know, if your hand has still got the plate in it from six months ago, you can't use your hand. That's your hand gone. But once that hand's back, you have a bit more freedom to do something, to help, to move things, to utilize it. Same with a limb, with prosthetic limbs or short limb lengthening and shortening whatever is necessary to get people on their feet again to give them back their autonomy, which has been stripped from them. Especially in terms of, you know, losing limbs. And it's very important for children. Children need ongoing as they grow. So it's not just one surgery for a limb that's been destroyed. You have to keep doing it as they get older and older into adulthood. So these are ongoing projects. So this is what I am hoping I will be a part of. And, you know, this is a project that with the W.H.O. has gained some ground. You know, it's got structure to it, it's got support, and we're doing it. Locals are leading it and we are supporting them. So we're not doing it to them. We're doing it with them. We are coming when they ask us to. We're not running this project. We help them set up the structure of it and now we will help them and they will become the leaders so that one day we don't need to go back. Saira, thank you again for taking the time to speak with us today and for sharing these reflections from your work in Gaza. This was not to forgive but to understand with our guest, Saira Hussain. To our listeners, don’t forget to like, subscribe and stay tuned for more discussions.