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‘It's shaming for me and appalling for humanity': The doctors bearing witness to Gaza
‘It's shaming for me and appalling for humanity': The doctors bearing witness to Gaza

The Age

time3 days ago

  • Health
  • The Age

‘It's shaming for me and appalling for humanity': The doctors bearing witness to Gaza

A young girl lies on an operating table in a hospital in Gaza. She has lost the use of both of her legs from a bomb blast. A British surgeon, Graeme Groom, is about to amputate both legs to save her life. But he does not know her name because she is one of so many patients he will treat each day. 'It's shaming for me and appalling for humanity that a seven-year-old child can have both her legs blown off and just be the next one on the conveyor belt,' he says. 'We can heal her residual legs, and she will not die if we can feed her. But when she's discharged, she will go – if she has family – to a tent where there will be no food. She will have no chance of prosthetic legs at the moment. She will go through life, however long that may be, totally changed.' Groom shows me a photograph of this child in London, where he is based at King's College Hospital, because I have asked to talk to him about his work as a volunteer surgeon. He is a medical expert with years of experience in limb reconstruction. He is also a witness to Gaza – a war zone few can see. Few journalists can enter. Most diplomats are barred. Groom, and a small number of volunteers like him, can tell us about the reality of this war. Now, with Israel intent on full control of Gaza despite international calls for a ceasefire, hearing these accounts feels more urgent than ever. One thing Groom has witnessed is a civilian population trapped without food. Others verify this when I seek them out. Israeli Prime Minister Benjamin Netanyahu denies it: 'There is no policy of starvation in Gaza and there is no starvation in Gaza,' he said last week. This makes it even more important to talk to those who have stood on Gazan soil. 'There were severe acute malnutrition cases diagnosed every day,' Groom says of his most recent work at Nasser Hospital, in Khan Younis in the southern part of the territory. 'In terms of deaths, the ones who are most at risk were neonates because their mothers, who were starving, could often not produce breast milk.' These babies were most exposed if they were lactose intolerant because there was no baby formula for them and very little for others. Groom visited the malnutrition clinic at Nasser Hospital and found that 60 babies who were lactose intolerant had died from March to the end of May. 'I think the notion that there is no starvation in Gaza is totally fanciful,' he says. 'And I don't know why anyone thinks it's helpful to argue otherwise. The effects of starvation will be so obvious.' Every statement about Gaza is contested. When international media reported on starvation in May, Israeli government spokesman David Mencer told Reuters that terrorist group Hamas had caused the hunger by stealing aid meant for civilians. Hamas denied this and blamed Israel for the starvation. Those who spoke to this masthead were in no doubt that the hunger, injury and death have grown worse under Israeli rules. The World Food Program says Gaza needs 62,000 tonnes of food a month; it was able to offload only 21,000 tonnes in the two months to the end of July. In the week to July 25, it asked Israeli authorities for permission to send 138 aid convoys to Gaza; only 76 requests were approved. British plastic surgeon Victoria Rose was in Gaza in May, also working at Nasser Hospital. She returned to London on June 4. She and Groom volunteer with charity group Ideals, which has sent medical help to the region since 2009. 'I can't tell you the level of malnutrition – it's shocking,' Rose says. 'You know, the kids are dying of malnutrition. Nobody has any food.' To illustrate this, she mentions the changes in what local staff have asked her to bring each time she arrives for several weeks of work. In December 2023, she says, they asked for mobile phones. In June 2024, they asked for clothing and shoes. In May this year, they needed multivitamins and energy bars. 'I can honestly tell you that it's impossible to operate on people that are this malnourished,' she says. 'None of their wounds heal. They've got zero body fat. They are skin and bone. They have not got the ability to mount an immune response because their immune systems are so depleted. They've got no nutrients and vitamins for normal cell turnover, so they don't repair at all. 'As well as that, you have infection. Everyone has a wound infection because there are no adequate antibiotics, because all aid has been stopped.' As a plastic surgeon, Rose has treated many of the patients who come to the hospital with burns from bomb blasts. But she has seen a change in the injuries over time. Blast wounds were most common in her earlier work, but there were more gunshot wounds after Israel overhauled aid distribution in May and the Gaza Humanitarian Foundation took over. 'The trip in May started very similarly to the others, but I'd say the blast injuries were worse, so we were seeing people with bits of them blown off. And I think that that's because 64 per cent of the infrastructure in Gaza has gone, so there are no buildings to shelter you, really. And now they're … tank-bombing tents, people in tents, so you're seeing a lot more direct impact on the body. 'And then in June, the gunshot wounds started again, and they were all from the Gaza Humanitarian Foundation distribution points.' Most wounds were to the abdomen and groin, some were to limbs. When Rose spoke to patients and interpreters, she heard that some had been shot when arriving for the food and some when they were running away. Did Rose see gunshot wounds that were compatible with the scenario of civilians being shot as they fled? 'Yes,' she says. 'I saw wounds in [the] back of legs.' Another surgeon, Nick Maynard, has been volunteering in Gaza for more than 15 years while also working as a gastrointestinal surgeon at Oxford University Hospitals. He told Good Morning Britain, on the ITV network, that he had seen more gunshot wounds on his most recent visit than at any previous point. He returned from Gaza three weeks ago with charity group Medical Aid for Palestinians. 'I saw, on this occasion, multiple gunshot wounds, almost exclusively on young teenage males – some of them as young as 11, 12, 13, 14 – all of whom had been shot at the food distribution points,' he told the network on July 25. 'I saw terrible injuries to the abdomen and the chest, but there was a very clear pattern of injuries, a cluster of injuries to specific body parts on particular days. So one day, for example, we'd see patients coming in with gunshot wounds just to the head and neck. On another day, they'd be coming in with gunshot wounds to the chest or the abdomen. The next day, the legs. On one day, about 12 days ago, we saw four young teenage boys – 13, 14 – all of whom had been shot, specifically, in the testicles.' Rose and Maynard were both cited in a Human Rights Watch report that blamed the increasing casualties on authorities at the aid distribution points. 'States should press Israeli authorities to immediately stop using lethal force as crowd control against Palestinian civilians, lift Israel's unlawful sweeping restrictions on the entry of aid, and for the United States and Israel to suspend this flawed distribution system,' Human Rights Watch said on August 1. Hamas, a listed terrorist group in Australia, has revealed its own atrocities. It took videos of the slaughter of Israeli civilians in the October 7, 2023 attack, and its fighters raped women. It released a video last week showing an emaciated Israeli man, Evyatar David, in a dark tunnel after being held hostage for 666 days. At one point in the video, David was handed a can of food that he said would have to last him two days. Netanyahu cited this as proof that Hamas was perpetrating 'Nazi' abuse. 'While the state of Israel is allowing the entry of humanitarian aid to the residents of Gaza, the terrorists of Hamas are deliberately starving our hostages and document them in a cynical and evil manner,' he said. Israel allows entry into Gaza for some surgeons, including those named in this feature, but the restrictions are tight. Groom has worked in Gaza on 45 visits over more than a decade. He used to be able to carry the medical equipment he needed. This changed after October 7, and it tightened again in May this year. He cannot take equipment, and he cannot carry more than about 1000 shekels, the Israeli currency, to help pay local staff. That is about $450. Maynard on July 25 said Israeli authorities had stopped medical teams from taking in baby formula. Groom has a stark way of describing the daily work at Nasser Hospital. 'We would spend the day with mutilated bodies and mangled limbs,' he says. One third of the casualties were children, one third were women and one third were men of all ages. Two operating theatres would work all day: one on orthopaedic surgery, one on plastic surgery, mainly for burns. Loading One patient stands out for Groom. A young boy was taken to the hospital at the end of May after a bomb blast left him badly wounded, and staff thought his arm would have to be amputated. Groom and others saved his arm and discovered who he was – his parents were both doctors at the hospital. The bomb had killed all nine of his siblings in their home. His father was rushed to hospital; he took eight days to die. His mother, a paediatrician, was the only other survivor because she had been working at Nasser Hospital that day. 'It's so horrible,' Groom says. The boy, Adam al-Najjar, 11, has since been evacuated with his mother, Dr Alaa al-Najjar. The BBC reported in June they would be settled in Italy. Adam stands out because he was saved, but he is one of thousands of casualties. 'He is typical of the people we would deal with. None of them were injured by themselves. None of them were injured alone. There were always groups of dead and wounded with them.' Groom worries about the long-term impact of the blast injuries, and the mental health of those who survive. United Nations Secretary-General Antonio Guterres calls Gaza a 'humanitarian catastrophe of epic proportions' and his officials estimate that more than 20,000 children have been treated for acute malnutrition. The World Food Program says more than 500,000 people, or about a quarter of Gaza's population, are enduring famine-like conditions. The death toll from the war in Gaza is estimated at 60,000. At Rafah, near the border with Egypt, the Red Cross Field Hospital relies on volunteers such as Rieke Hayes, a physiotherapist from Limerick in Ireland. She has worked with the International Committee of the Red Cross in Bangladesh, Nepal, North Korea, Iraq, Yemen and Ukraine. 'I've never quite seen the scale of civilian suffering that I have seen in Gaza,' she tells me. 'I've been in conflict zones for years now, about seven years, but it's just so comprehensive, the suffering.' She says this is not just about the shortage of food but the lack of fuel, the injuries, the destruction of housing and the military orders that have forced people to move a dozen times or more. Aerial footage highlighted the destruction this week when news photographers joined flights from Jordan to drop food aid. 'It was just a hellscape,' said ITV News international editor Emma Murphy, who was aboard a flight and spoke to the Columbia Journalism Review. Jordanian officials asked journalists not to film out the windows, apparently nervous that Israel would not allow further flights. Several outlets published the images anyway. Photographs taken on the ground, meanwhile, are contested. Israel has disputed an image of an emaciated Palestinian boy by saying he was suffering a genetic disease rather than starving. Israel has said some journalists in Gaza have staged photographs of starving civilians queuing for food. There is a shortage of primary reportage because so few gain access, limiting the mainstream media coverage as well as the social media posts. This is why it is so important to hear from those who enter Gaza and witness the war. Hayes says she saw a change in casualties after the GHF aid sites began operating towards the end of May. 'Every single day they were open, we had a mass casualty incident, sometimes two,' she says. It began with about 44 patients and rose quickly. One day, there were 244. Loading 'In my first six to seven weeks there, it was mostly blast injuries. Once the food distribution centres opened, it was predominantly bullet wounds that we're seeing in our emergency department. And the thing is, depending on where they hit you, those can result in amputations, really severe fractures, spinal cord injuries.' Two victims were rendered paraplegic; the hospital had only one wheelchair. 'I can't speak to the intention of anyone pulling a trigger. But yes, we had a lot of patients shot in the buttocks, in the back of the legs, and some of them said they had deliberately thrown themselves to the ground, you know, arms behind their heads to show that they're unarmed. And they said they were hit anyway. We did have some of those cases.' There is random death, also, even at a field hospital marked with the Red Cross sign. 'We had a 13-year-old who was in our outpatient department just waiting to be seen by a doctor,' Hayes says. 'A stray bullet came flying in and hit him in the head, and he was transferred to Nasser Hospital. He was in ICU, but he died a month later. To me, it doesn't matter who fired that bullet: at the end of the day, he was just a 13-year-old kid standing inside a hospital facility that you would hope would be safe. 'And there are so many of these stories. It's one after another.' Hayes is due to return to Gaza on Tuesday.

‘It's shaming for me and appalling for humanity': The doctors bearing witness to Gaza
‘It's shaming for me and appalling for humanity': The doctors bearing witness to Gaza

Sydney Morning Herald

time3 days ago

  • Health
  • Sydney Morning Herald

‘It's shaming for me and appalling for humanity': The doctors bearing witness to Gaza

A young girl lies on an operating table in a hospital in Gaza. She has lost the use of both of her legs from a bomb blast. A British surgeon, Graeme Groom, is about to amputate both legs to save her life. But he does not know her name because she is one of so many patients he will treat each day. 'It's shaming for me and appalling for humanity that a seven-year-old child can have both her legs blown off and just be the next one on the conveyor belt,' he says. 'We can heal her residual legs, and she will not die if we can feed her. But when she's discharged, she will go – if she has family – to a tent where there will be no food. She will have no chance of prosthetic legs at the moment. She will go through life, however long that may be, totally changed.' Groom shows me a photograph of this child in London, where he is based at King's College Hospital, because I have asked to talk to him about his work as a volunteer surgeon. He is a medical expert with years of experience in limb reconstruction. He is also a witness to Gaza – a war zone few can see. Few journalists can enter. Most diplomats are barred. Groom, and a small number of volunteers like him, can tell us about the reality of this war. Now, with Israel intent on full control of Gaza despite international calls for a ceasefire, hearing these accounts feels more urgent than ever. One thing Groom has witnessed is a civilian population trapped without food. Others verify this when I seek them out. Israeli Prime Minister Benjamin Netanyahu denies it: 'There is no policy of starvation in Gaza and there is no starvation in Gaza,' he said last week. This makes it even more important to talk to those who have stood on Gazan soil. 'There were severe acute malnutrition cases diagnosed every day,' Groom says of his most recent work at Nasser Hospital, in Khan Younis in the southern part of the territory. 'In terms of deaths, the ones who are most at risk were neonates because their mothers, who were starving, could often not produce breast milk.' These babies were most exposed if they were lactose intolerant because there was no baby formula for them and very little for others. Groom visited the malnutrition clinic at Nasser Hospital and found that 60 babies who were lactose intolerant had died from March to the end of May. 'I think the notion that there is no starvation in Gaza is totally fanciful,' he says. 'And I don't know why anyone thinks it's helpful to argue otherwise. The effects of starvation will be so obvious.' Every statement about Gaza is contested. When international media reported on starvation in May, Israeli government spokesman David Mencer told Reuters that terrorist group Hamas had caused the hunger by stealing aid meant for civilians. Hamas denied this and blamed Israel for the starvation. Those who spoke to this masthead were in no doubt that the hunger, injury and death have grown worse under Israeli rules. The World Food Program says Gaza needs 62,000 tonnes of food a month; it was able to offload only 21,000 tonnes in the two months to the end of July. In the week to July 25, it asked Israeli authorities for permission to send 138 aid convoys to Gaza; only 76 requests were approved. British plastic surgeon Victoria Rose was in Gaza in May, also working at Nasser Hospital. She returned to London on June 4. She and Groom volunteer with charity group Ideals, which has sent medical help to the region since 2009. 'I can't tell you the level of malnutrition – it's shocking,' Rose says. 'You know, the kids are dying of malnutrition. Nobody has any food.' To illustrate this, she mentions the changes in what local staff have asked her to bring each time she arrives for several weeks of work. In December 2023, she says, they asked for mobile phones. In June 2024, they asked for clothing and shoes. In May this year, they needed multivitamins and energy bars. 'I can honestly tell you that it's impossible to operate on people that are this malnourished,' she says. 'None of their wounds heal. They've got zero body fat. They are skin and bone. They have not got the ability to mount an immune response because their immune systems are so depleted. They've got no nutrients and vitamins for normal cell turnover, so they don't repair at all. 'As well as that, you have infection. Everyone has a wound infection because there are no adequate antibiotics, because all aid has been stopped.' As a plastic surgeon, Rose has treated many of the patients who come to the hospital with burns from bomb blasts. But she has seen a change in the injuries over time. Blast wounds were most common in her earlier work, but there were more gunshot wounds after Israel overhauled aid distribution in May and the Gaza Humanitarian Foundation took over. 'The trip in May started very similarly to the others, but I'd say the blast injuries were worse, so we were seeing people with bits of them blown off. And I think that that's because 64 per cent of the infrastructure in Gaza has gone, so there are no buildings to shelter you, really. And now they're … tank-bombing tents, people in tents, so you're seeing a lot more direct impact on the body. 'And then in June, the gunshot wounds started again, and they were all from the Gaza Humanitarian Foundation distribution points.' Most wounds were to the abdomen and groin, some were to limbs. When Rose spoke to patients and interpreters, she heard that some had been shot when arriving for the food and some when they were running away. Did Rose see gunshot wounds that were compatible with the scenario of civilians being shot as they fled? 'Yes,' she says. 'I saw wounds in [the] back of legs.' Another surgeon, Nick Maynard, has been volunteering in Gaza for more than 15 years while also working as a gastrointestinal surgeon at Oxford University Hospitals. He told Good Morning Britain, on the ITV network, that he had seen more gunshot wounds on his most recent visit than at any previous point. He returned from Gaza three weeks ago with charity group Medical Aid for Palestinians. 'I saw, on this occasion, multiple gunshot wounds, almost exclusively on young teenage males – some of them as young as 11, 12, 13, 14 – all of whom had been shot at the food distribution points,' he told the network on July 25. 'I saw terrible injuries to the abdomen and the chest, but there was a very clear pattern of injuries, a cluster of injuries to specific body parts on particular days. So one day, for example, we'd see patients coming in with gunshot wounds just to the head and neck. On another day, they'd be coming in with gunshot wounds to the chest or the abdomen. The next day, the legs. On one day, about 12 days ago, we saw four young teenage boys – 13, 14 – all of whom had been shot, specifically, in the testicles.' Rose and Maynard were both cited in a Human Rights Watch report that blamed the increasing casualties on authorities at the aid distribution points. 'States should press Israeli authorities to immediately stop using lethal force as crowd control against Palestinian civilians, lift Israel's unlawful sweeping restrictions on the entry of aid, and for the United States and Israel to suspend this flawed distribution system,' Human Rights Watch said on August 1. Hamas, a listed terrorist group in Australia, has revealed its own atrocities. It took videos of the slaughter of Israeli civilians in the October 7, 2023 attack, and its fighters raped women. It released a video last week showing an emaciated Israeli man, Evyatar David, in a dark tunnel after being held hostage for 666 days. At one point in the video, David was handed a can of food that he said would have to last him two days. Netanyahu cited this as proof that Hamas was perpetrating 'Nazi' abuse. 'While the state of Israel is allowing the entry of humanitarian aid to the residents of Gaza, the terrorists of Hamas are deliberately starving our hostages and document them in a cynical and evil manner,' he said. Israel allows entry into Gaza for some surgeons, including those named in this feature, but the restrictions are tight. Groom has worked in Gaza on 45 visits over more than a decade. He used to be able to carry the medical equipment he needed. This changed after October 7, and it tightened again in May this year. He cannot take equipment, and he cannot carry more than about 1000 shekels, the Israeli currency, to help pay local staff. That is about $450. Maynard on July 25 said Israeli authorities had stopped medical teams from taking in baby formula. Groom has a stark way of describing the daily work at Nasser Hospital. 'We would spend the day with mutilated bodies and mangled limbs,' he says. One third of the casualties were children, one third were women and one third were men of all ages. Two operating theatres would work all day: one on orthopaedic surgery, one on plastic surgery, mainly for burns. Loading One patient stands out for Groom. A young boy was taken to the hospital at the end of May after a bomb blast left him badly wounded, and staff thought his arm would have to be amputated. Groom and others saved his arm and discovered who he was – his parents were both doctors at the hospital. The bomb had killed all nine of his siblings in their home. His father was rushed to hospital; he took eight days to die. His mother, a paediatrician, was the only other survivor because she had been working at Nasser Hospital that day. 'It's so horrible,' Groom says. The boy, Adam al-Najjar, 11, has since been evacuated with his mother, Dr Alaa al-Najjar. The BBC reported in June they would be settled in Italy. Adam stands out because he was saved, but he is one of thousands of casualties. 'He is typical of the people we would deal with. None of them were injured by themselves. None of them were injured alone. There were always groups of dead and wounded with them.' Groom worries about the long-term impact of the blast injuries, and the mental health of those who survive. United Nations Secretary-General Antonio Guterres calls Gaza a 'humanitarian catastrophe of epic proportions' and his officials estimate that more than 20,000 children have been treated for acute malnutrition. The World Food Program says more than 500,000 people, or about a quarter of Gaza's population, are enduring famine-like conditions. The death toll from the war in Gaza is estimated at 60,000. At Rafah, near the border with Egypt, the Red Cross Field Hospital relies on volunteers such as Rieke Hayes, a physiotherapist from Limerick in Ireland. She has worked with the International Committee of the Red Cross in Bangladesh, Nepal, North Korea, Iraq, Yemen and Ukraine. 'I've never quite seen the scale of civilian suffering that I have seen in Gaza,' she tells me. 'I've been in conflict zones for years now, about seven years, but it's just so comprehensive, the suffering.' She says this is not just about the shortage of food but the lack of fuel, the injuries, the destruction of housing and the military orders that have forced people to move a dozen times or more. Aerial footage highlighted the destruction this week when news photographers joined flights from Jordan to drop food aid. 'It was just a hellscape,' said ITV News international editor Emma Murphy, who was aboard a flight and spoke to the Columbia Journalism Review. Jordanian officials asked journalists not to film out the windows, apparently nervous that Israel would not allow further flights. Several outlets published the images anyway. Photographs taken on the ground, meanwhile, are contested. Israel has disputed an image of an emaciated Palestinian boy by saying he was suffering a genetic disease rather than starving. Israel has said some journalists in Gaza have staged photographs of starving civilians queuing for food. There is a shortage of primary reportage because so few gain access, limiting the mainstream media coverage as well as the social media posts. This is why it is so important to hear from those who enter Gaza and witness the war. Hayes says she saw a change in casualties after the GHF aid sites began operating towards the end of May. 'Every single day they were open, we had a mass casualty incident, sometimes two,' she says. It began with about 44 patients and rose quickly. One day, there were 244. Loading 'In my first six to seven weeks there, it was mostly blast injuries. Once the food distribution centres opened, it was predominantly bullet wounds that we're seeing in our emergency department. And the thing is, depending on where they hit you, those can result in amputations, really severe fractures, spinal cord injuries.' Two victims were rendered paraplegic; the hospital had only one wheelchair. 'I can't speak to the intention of anyone pulling a trigger. But yes, we had a lot of patients shot in the buttocks, in the back of the legs, and some of them said they had deliberately thrown themselves to the ground, you know, arms behind their heads to show that they're unarmed. And they said they were hit anyway. We did have some of those cases.' There is random death, also, even at a field hospital marked with the Red Cross sign. 'We had a 13-year-old who was in our outpatient department just waiting to be seen by a doctor,' Hayes says. 'A stray bullet came flying in and hit him in the head, and he was transferred to Nasser Hospital. He was in ICU, but he died a month later. To me, it doesn't matter who fired that bullet: at the end of the day, he was just a 13-year-old kid standing inside a hospital facility that you would hope would be safe. 'And there are so many of these stories. It's one after another.' Hayes is due to return to Gaza on Tuesday.

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

The Guardian

time6 days ago

  • Health
  • The Guardian

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

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'.

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