‘The worst cases are the children': British burns doctor in Gaza says health system is overwhelmed
Dr Tom Potokar said he had been operating on 10 to 12 patients each day at hospitals in the besieged territory, but had still not been able to treat everyone who needed surgery.
The experienced plastic surgeon has done 16 stints as a volunteer in Gaza's hospitals in recent years, including several since the beginning of Israel's military retaliation following Hamas' October 7 attacks.
Many of those he treated since the campaign began had burns from blasts, while three-quarters of those cases have been women or children.
He told the Telegraph: '[You are] operating on 10 to 12 patients per day, but that's taking the top 10 priority, but there's still plenty more behind that that needed operating.'
He said in the first six weeks after Israel began its military campaign following the Hamas Oct 7 attacks, every patient he operated on had a burn injury.
With the densely populated territory under air strikes and ground operations for much of the past two years, the high incidence of burns had continued.
Plastic surgery is one of the most sorely needed surgical disciplines during a conflict, and the lack of burns expertise in poorer countries and war zones in 2006 led him to found the medical charity Interburns, to try to improve care.
He has also been Professor of Global Burn Injury at Swansea University and consultant plastic surgeon at the Welsh Centre for Burns and Plastic Surgery.
When he first worked in Gaza in 2018, there were only two fully qualified specialists, one of them partially retired.
In his most recent trip, in May and June this year working with the Ideals international aid charity, he said he has seen 'horrendous injuries from blasts, including limbs being ripped off'.
'I saw many cases of bilateral or triple limb amputations, huge open wounds on the back, on the chest, with the lung exposed. Really horrendous blast injuries from shrapnel and as I say, a lot of them combined with burns as well.'
'The cases that are the worst are the ones where it's children,' he said.
'In October 2023, I remember one child that really sank in because I think they were about nine or 10 and they had about 90 per cent burns and you know that they are not going to survive,' he told the Telegraph.
'There's nothing you can do. Even if there was not a conflict there, in that country, in that scenario, a 90 per cent burn when it's almost all full thickness is not going to survive.
'There's nothing you can do because you are short of supplies, to the point where it's even difficult to justify dressing the wounds because you need the dressings for patients that are going to survive.
'But then you are talking about a nine-year-old and some end of life dignity and unfortunately they don't die in a couple of hours, it takes four or five days, so you see this patient every four or five days, knowing full well that there's absolutely nothing you can do.'
Over the past 35 years, he has worked in war zones and humanitarian crises such as South Sudan and Ukraine, but says the situation inside Gaza is particularly bad.
The Hamas-run health ministry says more than 62,000 Palestinians have been killed since the start of the conflict. The ministry does not distinguish between civilians and combatants, but has said that women and children make up more than half the dead. Israel says those figures are inflated, others that they are underestimates.
Recent months have seen a spate of mass shootings at aid distribution points run by the controversial new Gaza Humanitarian Foundation (GHF) set up by the US and Israel to bypass United Nations-run distributions.
Aid distributions have been marred by chaotic scenes and frequent reports of Israeli forces firing on people waiting to collect rations.
The UN said this week that Israeli forces had killed over 1,000 Palestinians trying to get food aid in Gaza since the GHF began operations in May.
Israel's military has disputed previous death tolls, but has said its troops have at times fired warning shots and it is investigating accusations of civilian deaths.
'A very, very unpleasant scenario'
Dr Potokar said he witnessed the chaotic aftermath of one such shooting incident on June 1, when Nasser Hospital was flooded with casualties.
He said: 'When that happens, it's just chaos because you have everyone coming in, you have relatives coming in, family coming, you have people screaming, you have one ambulance after another, then you have a truck coming in with bodies on the back of it.
'The casualty department becomes completely overwhelmed.'
'The concept of triage is very difficult when you get hundreds, not 20 but hundreds.
'There's lots of shouting, lots of screaming, it's a very, very unpleasant scenario to be in and quite tense.'
Supplies were short in hospitals, he said, but the biggest limitations were in time and staff, because of the sheer number of casualties.
Food shortages were also affecting patients and staff alike. Malnutrition was weakening patients, meaning they struggled to recover from surgery or heal.
He said: 'Patients are skin and bone, they are not healing, they are getting infected more than they should be. Wounds are just stagnating because they are just not getting food.'
On his most recent trip, he lost 24lb (11kg) over four weeks, despite taking his own food with him.
Palestinian staff he worked alongside were increasingly fatalistic.
He said: 'One half are just waiting to die, saying 'I probably won't see you next time because I will probably be dead' versus the others who are [looking for] any chance to get out.'
The need for his skills and the relentless casualties meant he could not let the situation get to him while working, he said.
'Nobody wants you breaking down in tears and not being able to function, that's not going to help anyone. You have to just get on with the job, knowing that basically, what you are doing is lifting up the carpet, sweeping all the – whatever you want to call it: reaction, response, emotion whatever – underneath and putting the carpet back down and leaving it to come out at some other point.'
He said he was more affected by the lack of response from the rest of the world to what he said was the 'world's first televised genocide'.
Dr Omer Bartov, a professor of Holocaust and genocide studies at Brown University, and former IDF soldier, recently wrote in the New York Times that Israel was no longer fighting a war against Hamas, but waging 'an operation of demolition and ethnic cleansing' in the ravaged enclave.
'I have been teaching classes on genocide for a quarter of a century. I can recognise one when I see one,' he added.
Israel has strongly rejected claims, including at the UN's top court, that its actions in Gaza amount to a genocide.
Dr Potokar said: 'We are putting plasters on a haemorrhaging aneurysm. The problem is the political initiative, the total lack of global, moral, ethical insight into this and desire to stop it.'
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Despite the visible wasting, fluid retention caused by a lack of protein can lead to swelling in the feet, ankles, or tummy. Many Telegraph readers will remember similar images of small children with large, protruding bellies trickling out from Biafara in the 1960s and Ethiopia in the 1980s. People feel constantly cold; with the thyroid suppressed and fat stores gone, the body no longer generates enough heat. Movement becomes slow and exhausting, even basic tasks may be impossible, and mental fog, apathy, or confusion set in. Some will start to hallucinate, say experts. If death doesn't come from heart failure, it often results from infection – something as simple as a cold or skin wound – because the immune system has collapsed beyond repair.
