‘Heartbreaking': a London surgeon on the trials of operating in a Gaza hospital

The Guardian

2 days ago

Every day between 4am and 6am, Graeme Groom, an orthopaedic surgeon from London, would be woken by a dawn chorus of bombs and missiles. And so began another 24 hours at the Nasser hospital in Gaza, the largest functioning hospital in the territory. Shortly after 8am, the first patients would be wheeled into the operating theatres.
Groom and his orthopaedic and plastic surgery colleagues saw on average 20 patients a day: one-third children, one-third women, then men of all ages, their limbs mangled by bombs and guns.
Groom, a co-founder of the charity Ideals that provides health services in places affected by conflict, has been to Gaza about 40 times, including four visits since Hamas militants attacked Israel on 7 October 2023. One evening on his most recent trip, just as the 12-hour-plus shift was ending, another emergency was wheeled in.
It was an 11-year boy who had lost his nine siblings in an Israeli strike on their family home in Khan Younis. His father, a doctor, was in a critical condition, and later died of his injuries. That night Groom and his team managed to save the boy's arm, rather than amputate it. The boy's name was Adam al-Najjar. As Adam got better, the NHS doctor found that Adam spoke good English and had 'the most angelic smile', which could be prompted by a bar of chocolate from the surgeon's pocket.
A few weeks later Adam and his mother were evacuated to Italy. Physically, he was much better by the time he left, Groom said, although it was too early to assess the long-term impact of the explosion on his brain, or the mental scars. 'We could not begin to get a mental health assessment of the effects of losing almost all his family in one bomb.'
For every Palestinian child whose trauma captures headlines, there are thousands more whose stories go untold. The UN agency for children reported on 16 July that more than 17,000 children have been killed and 33,000 injured in the 21-month conflict.
The NHS doctor recalls seven-year-old Yakub, who, with his older brother, was the only survivor of a bomb attack. Yakub's legs had been broken above and below the knees, the skin and much soft tissue flayed by bombs. 'While I was writing up the operation note … it was just heartbreaking to hear him calling for the mother who was dead.'
He recalls two other patients: a mother who was cradling her three-year-old daughter when the bombs exploded. The child lost both legs, the mother's elbows were damaged, depriving her of the use of her arms. She is now regaining the use of one arm.
Patients are usually discharged to tents, or improvised shelters in the sand, without rehabilitation. They are malnourished, so wounds heal less well. Infection rates are high and it is hard to keep track of them for follow-up. But it is happening. 'Amazing Palestinian colleagues are doing their very best … [and] without it, the mortality and the long-term disability rate would be much, much higher,' Groom said.
The Ideals charity has been sending medical teams to the occupied Palestinian territories since 2009. But never before has it been so hard to bring in supplies. In the past Groom alone brought five large cases. On the most recent visit, his team was banned 'under pain of exclusion, confiscation and possible penalty' from bringing desperately needed equipment such as delicate plastic surgery tools for repairing vein and tissue or orthopaedic frames that allow broken bones to heal.
Since the Ideals team first went to Gaza there have always been damaged buildings, but 'absolutely nothing to compare with the apocalyptic destruction that is everywhere' now.
All his Palestinian colleagues have been forced to move, some many times. Many have lost close relatives, or most of their extended families. They live in tents near the hospitals with self-dug latrines for toilets. One woman slept in her hijab each night, 'so that if she was killed, she would be presentable', he recalled. 'What was astonishing was how many of them would turn up for work each day from their tents … clean, well-dressed and smiling.'
Several appeared to shrug off unimaginable personal suffering. 'When they talked about the loss of family members … they would say 'this is our lives'. I probably have heard that a dozen times,' Groom said of his Palestinian colleagues. Several have also told him they do not want to be known as resilient. They just want the bombing to stop, said Groom.
At his most recent visit, from 13 May to 4 June, market stalls had almost disappeared. Unrwa, the UN agency for Palestinian refugees, reported on Tuesday that doctors and nurses were among people 'fainting from hunger and exhaustion', having previously said Israeli authorities were 'starving civilians'.
On 20 July, an anaesthetist, who was also a parent to six children, told Groom that he and his family were starving. His children ranging from two to 13 are suffering from fatigue, weakness, cramps and amnesia. They were confused, they were crying, the anaesthetist said in messages to Groom seen by the Guardian. The anaesthetist could only give them salt to lick and water.
Groom has relayed what he has witnessed in Gaza to policymakers in Brussels, Berlin and Paris, urging greater western pressure on Israel. 'Everywhere we were met with empathy, very often with tears, but with a sense of impotence.' After he spoke to the Guardian, the European Commission proposed a partial suspension of Israel's participation in the EU research programme, the first possible punitive measure against the Israeli government, which must be agreed by a majority of member states to take effect.
Groom had been 'hugely disappointed' when earlier this month EU foreign ministers took no action following a review into the bloc's relations with Israel, 'but I don't think the fight is over'.