The 35 American and other international doctors came to Gaza in volunteer teams to help one of the territory's few hospitals still functioning. They brought suitcases full of medical supplies and had trained for one of the worst war zones in the world. They knew the healthcare system was decimated and overwhelmed.
The reality is even worse than they imagined, they say.
Children with horrific amputations. Patients with burns and maggot-filled wounds. Rampant infections. Palestinian doctors and nurses who are beyond exhausted after 7 months of treating never-ending waves of civilians wounded in .
"I did not expect that (it) will be that bad," said Ammar Ghanem, MD, an intensive care unit specialist from Detroit with the Syrian American ľֱ Society. "You hear the news, but you cannot really recognize ... how bad until you come and see it."
Now the foreign doctors are trapped, living at the southern Gaza hospital where they work. They were meant to leave days ago. But on May 6, Israeli troops as they launched an incursion , closing the main entry and exit point for international humanitarian workers. Talks to evacuate the doctors between their governments and Israel – which controls all access to Gaza – have gone nowhere.
Ghanem spoke from the European General Hospital, just outside Rafah, the largest hospital still operating in southern Gaza, where the two international teams have worked since early May on what was supposed to be a 2-week mission. The volunteers consist mostly of American surgeons but also medical professionals from Britain, Australia, Egypt, Jordan, Oman, and other nations.
One team of 17 doctors from the U.S.-based group FAJR Scientific were living in a guesthouse in the city when Israel's . With no warning from the Israeli army to evacuate, the team was stunned by bombs landing a few hundred meters from the clearly-marked house, said Mosab Nasser, FAJR's CEO.
They scrambled out, still wearing their scrubs, and moved to the European Hospital, where the other team was staying. The doctors say they don't leave the premises.
Nasser said negotiations to get them out have been stop-and-go. Twice, they were told to get ready to leave, then told to stand down.
The U.S. State Department says it is working with Israel and Egypt for their departure, but offered no details. Illinois U.S. Sen. Tammy Duckworth (D) said she is pushing as well. She credits one of the trapped surgeons, Adam Hamawy, MD, of Princeton, New Jersey, with saving her life when, as a military pilot in Iraq in 2004, her helicopter was hit by a rocket-propelled grenade, causing injuries that cost her her legs.
The U.N. coordinates visits of volunteer teams, including arranging their entry and exit, almost always via Rafah. The World Health Organization said the U.N. is in talks with Israel on resuming movement of all humanitarian workers in and out of Gaza, which has halted since the Rafah incursion began. The Israeli military said it had no comment.
The Israeli offensive in Gaza, triggered by on southern Israel, has killed more than 35,000 Palestinians and wounded more than 79,000, according to Gaza health officials. Almost 500 health workers are among the dead.
Nearly two dozen hospitals in Gaza have been put out of service following Israeli raids or strikes. Israel alleges that Hamas uses and hideouts, an accusation Gaza health officials deny. The dozen hospitals remaining only partially operate.
Israel's nearly 2-week-old Rafah operation has . More than 600,000 Palestinians have fled the city, scattering across southern Gaza. Much of the European Hospital's Palestinian staff left to help families find new shelter. As a result, the foreign volunteers are stretched between medical emergencies and other duties, such as trying to find patients inside the hospital. There is no staff to log where incoming wounded are placed.
Thousands of Palestinians are sheltering in the hospital. Outside, sewage overflows in the streets, and drinking water is brackish or polluted, spreading disease. The road to the hospital from Rafah is now unsafe: The United Nations says an Israeli tank fired on a marked U.N. vehicle on the road Monday, killing a U.N. security officer and wounding another.
Mohamed Tahir, MBBS, an orthopedic surgeon from London with FAJR, does multiple surgeries a day on little sleep. He's often jolted awake by bombings shaking the hospital. Work is frantic. He recalled opening one man's chest to stop bleeding, with no time to get him to the operating room. The man died.
Tahir said when the Rafah assault began, Palestinian colleagues at the hospital nervously asked if the volunteers would leave.
"It makes my heart feel really heavy," Tahir said. The Palestinian staff knows that when the teams leave "they have no more protection; and that could mean that this hospital turns into Shifa, which is a very real possibility." Israeli forces , the territory's largest, for a second time in March, leaving it in ruins. Israel says the damage was from fighting with militants inside.
The patients Tahir has saved keep him going. Tahir and other surgeons operated for hours on a man with severe wounds to the skull and abdomen and shrapnel in his back. They did a second surgery on him Wednesday night.
"I looked at my colleagues and said, 'You know what? If this patient survives -- just this patient -- everything we've done, or everything we've experienced, would all be worth it,'" Tahir said.
Ahlia Kattan, MD, an anesthesiologist and intensive care unit doctor from California with FAJR, said the hardest case for her was a 4-year-old boy, the same age as her son, who arrived with burns on more than 75% of his body, his lungs and spleen shattered. He didn't survive.
"He reminded me so much of my son," she said, holding back tears. "Everyone has different stories here that they're taking home with them."
Kattan and other doctors say they need to get home, with families and jobs waiting for them. But they want new teams that are ready to replace them to be allowed in.
Weighing heavily on all the volunteers, Kattan said, is "the guilt that we're already feeling when we leave, that we get to escape to safety."