Interview

Change

Middle East

S&U interviews

War & peace

12 February 2024

11 min read

Eye witness: life and death in Gaza’s European Hospital

Returning plastic surgeon Tim Goodacre reports on the struggles, the despair and the dignity of the people and the medics of Gaza during their long nightmare.

Graham Tomlin

Graham is the Director of the Centre for Cultural Witness and a former Bishop of Kensington.

Medical staff stand beside a bed in which a man lies with an amputated leg.

Medics confer about a patient in Gaza's European Hospital.

Tim Goodacre

Tim Goodacre is a vastly experienced plastic surgeon who recently spent two weeks in a hospital in Khan Younis treating the extensive injuries of the people of Gaza. I caught up with him to ask about his experience there.

Graham: Let me start by asking what was it like getting into Gaza? What was the process and how difficult was it to actually get in in the first place?

Tim: We went in as an emergency medical team under the under the auspices of the World Health Organisation, which is coordinated with UN OCHR. It was easy obviously to get to Cairo. Then we joined a convoy, a group of cars convening in the small hours of the morning in Cairo and then being escorted across the Sinai desert. We got to the border in time for dusk. What was staggering at that stage was seeing the number of lorries lined up, waiting on the Egyptian side to get in. They were two deep on one side, one deep on the other with a thin passageway through which we could drive through for mile after mile after mile of these lorries.

Was this humanitarian aid sent from other nations?

Absolutely. It was aid labelled from different countries or agencies. Crossing Rafah the next morning was all pretty haphazard and chaotic, but we met our driver on the other side. We then had to travel to Khan Yunis on the coast road because it was the safest part of the south Gaza strip. We went through a route called the Philadelphia Road, which is a gap between the two borders. As we drove along, we immediately were jumped on by some young lads who had put razor wire across the road. We picked up two of them who hung onto the car each side, with our window s firmly shut. As we sped along, they were our ‘protectors’, taking a pitiful sum to ensure that we would not be stopped at further razor wire and our vehicle plundered. It was our first experience of the lawlessness that's inherent at the moment in Gaza.

All along that side of the road there were people putting up new tents after a recent further mass displacement, as far as the eye could see. It made a huge impact on me - the devastating plight of the people who were there. It looked like those pictures of Glastonbury or Woodstock, where as far as you could see, the rolling fields or sand dunes or whatever were totally covered in makeshift dwellings. It was pretty cold and windy. And subsequently, while we were there, it rained an awful lot and your heart just went out to these people.

So these were people living in tents and temporary shelters?

Well, not really. They're barely tents. They're just finding flimsy bits of wood, putting them up and nailing them together. And these are not just the very poorest of the poor. This is everybody. Many of them were people from very well-to-do houses whose families have been displaced. I've worked in many parts of the world where there's poverty, but I’ve never seen so many people displaced.

One of the things that's remarkable however is the relative cleanliness, the desire to maintain dignity in the most appalling circumstances. But a young lad who’s now a young doctor (who I have worked with for a decade now) came to see me and he was the most dejected person I've ever met. He said to me ‘they've taken away my dignity’. The abject pain in his face was something that I won't forget.

You’ve been to Gaza many times before. What was different about this time? And you've seen it in the aftermath of previous wars and conflicts. What was what was particularly different this time?

It's utterly different – it’s the displaced population with nowhere to go and seeking shelter. When I first went in 2014 after Operation Protective Edge, I was taken to a huge neighbourhood of northeast Gaza, which had been flattened and at the time the impact on me was extraordinary. When I’ve visited subsequently over the last decade, they will show you this bombed out building and that flattened area, but I've never seen such vast numbers of displaced people. On the second day we moved into the European Gaza Hospital (EGH), which is where we were going to stay for the two weeks we were there. Inching slowly along amidst endless hordes of people walking around, seeing the dejection, despair, the hopelessness with nowhere to go - this for me is what defines this whole episode and makes it very different from others. This is in no way a diminution of other conflicts and human tragedies, but when there was bombing in Baghdad or in Kiev and Ukraine, people might go into underground shelters - there are places they can perhaps go to escape. Even in massacres such as in Darfur or Congo, there are places to run to. There is nothing like that in Gaza.

Was there a pattern to the kind of medical emergencies and wounds that you were having to deal with?

The vast majority of injuries were the impact of high explosives, so we naturally saw quite a lot of burns, although the majority of severe burns alone were being managed by the Red Cross team also at EGH. Some of them were people who had been crushed and pulled out of buildings which had collapsed. But that was that was the minority. The majority of our cases were direct results of bomb blasts. Every time you hear a bomb, somebody is being killed, yet many others are caught on the fringe of that. Shrapnel travels at astronomical speeds and hits people in in a completely random way. These injuries are devastating. There were scores of people coming in with limbs missing. Seeing somebody with a leg off at the thigh, a leg off below the knee, an arm ripped off was all too common. It was hard to take in - you have to become somewhat immune to the backstory behind each dreadful injury, and concentrate on the carnage in front of you, to be able to deal with the constant onslaught of cases.

How were the medics coping with it? You were there for two weeks. They are there for months, presumably on end?

I think it's incredibly important that we don't focus on the visiting medics. I usually peeled off at about 9pm or so in the evening - I had to go to bed and had to have a rest, but there were people trying to work through the night. What I want to focus on is the local people, particularly a young colleague, Ahmed, who was 36 years-old. He was statesmanlike in his ability to pull things together. His family are actually mostly in Dublin as they've got Irish passports. I cannot tell you how much admiration I have for that young Gazan man who shared his room with me.

He has been managing to create a team who work alongside him, since many of the staff who had worked at the hospital before (some of whom we had trained over several years in limb reconstruction) were not there. That is because they might not be alive, or having to support their displaced families, or simply are afraid to travel in daily to the hospital, or whatever. It is a huge demand on individual doctors to leave a family group (who invariably try to stay together, so that if they are bombed, they all die together and do not have to be a sole survivor.) to then work away from such possible loss of all their family members. It's an incredible sacrifice to be working in medical care when your family are all huddled together in a place where they may all lose their life, and that gets to them in the end.

The orthopaedic side is almost on its knees. Most of the system in the hospital is utterly on its knees. There were early years medical students who had been taught quickly how to manage wounds and to skin graft. They haven't got any pay, but some people have given a little money to my colleague’s account to try and give them some support. There were IT students and all sorts of others pulling together. How people can work in in such adversity and make things happen is quite a testament to the to the strength of humanity.

It all begins to play on your mind, and you start thinking is there another one coming? And you get no warning when the attacks are unleashed.

What was it like living under the bombardment, which was presumably pretty constant during your time there?

There may have been the odd period of four or five hours when there was no sound of close bombardment at all, although during that time there was probably small arms fire going on somewhere. But otherwise, it was relentless. One became somewhat used to the bombs in the distance, but when they're close by… Every time one of these bombs goes off, there are people dying. And that really that played on your mind. So huge numbers were seeking shelter anywhere in the vicinity of the hospital. If you can imagine a hospital corridor where every route is full of makeshift shelters, and you just go up around a stairwell and on the corner of each stair, there will be a family which will be hanging drapes up, trying to find some sort of privacy and dignity among the utter destitution.

I found it very difficult to sleep during those times. The hospital is in a quadrant, a square. On one corner there was a supermarket which latterly was hit by an F16 delivered weapon. You could hear the sound of the rocket go off alongside the scream of the low flying fighter jet, and the whole building shook. There's also the incessant sound of drones. It all begins to play on your mind, and you start thinking is there another one coming? And you get no warning when the attacks are unleashed.

It made me realise what soldiers undergo when they get what used to be called shell shock. There, even if you're not injured yourself, this constant shocking damage gets to you. I knew we had the knowledge that after a short time, we would be getting out - but it made me realise how tough Ahmed and others working there have to be. It will be having a devastating impact on the population, and for a nation.

I imagine the psychological effects of that are going to last for a long time in the lives of these people. You don't get over that quickly. If you live with that level of tension, thinking any moment now, I could die, that must stay with you and the marks of that stay for a long time.

I'm sure that's true. I'm not an expert in PTSD and things like that. Ahmed is a Muslim and said to me more than once that when you believe in an afterlife, you believe that your time will come at some point, and you accept that. We don't know when it is or where it is, but it will come. I have frequently wondered whether any of the fighter jet pilots have ever experienced themselves what it’s like to be underneath the impact of one of their weapons? Having felt somewhat what it is like to be on the other side of such an onslaught, I do wonder whether very many of those involved in ordering conflict really have any kind of understanding of what devastation feels like, when there is nowhere to run? I fear for what this conflict does to the humanity of both sides.

I genuinely don't feel brave, I don't. I'm not the kind of person who sees lights in the sky, but I know it was God’s calling to go there. It was simply the right thing,

Did you see any sign of hope or anything that gave you a sense of the way out of this?

The sense of hope is within the people who are there. There are many people who say they still really don't want to leave. They feel this passionately. It's their land. They do want to see a new Gaza. I tried to be somebody who lifted spirits. Communities can be rebuilt and there may be a new future which will come from the dust. I've been in touch with people in my University Medical school in Oxford to see whether we can do something about getting these young people's education continued.

You can imagine there wasn’t a lot of laughter in the whole environment, but on the few occasions when I did gather together with my colleague’s small group of young students and volunteers, usually late into the night, we would eat whatever food goodies they had to hand, and their sense of fun would burst out. Together there was a very strong sense of community amongst them.

How did your Christian faith inform the way you interacted with the situation? How did your Christian faith help you process what you were seeing and experiencing there?

I must say it was a deeply spiritual time for me. It was absolutely powerful to me to know that God cares and loves each and every one of these people. I longed to organise a football game with the kids. I was told that they had tried to do that, and it had become too dangerous. So there seemed to be no organisation around looking after the well-being of the children, their education, or the deeper impact on them of this war. People were jammed into the hospital, obviously because it was seen as a safe space, and it was humbling to think that us (as foreign workers) being there made them feel somewhat safer. It humbled me immensely.

I felt nothing but a sense of privilege in being a witness to all this. I was reading the Psalms regularly in daily prayer. There's also something about that land being the place where God himself suffered in Christ and went through his own agony, and that the Holy Family escaped through Gaza to Egypt.

I genuinely don't feel brave, I don't. I'm not the kind of person who sees lights in the sky, but I know it was God’s calling to go there. It was simply the right thing, a privilege and an honour to have such access which comes with having my particular background of skills and past history with Gaza. God is over all these matters, and we are compelled to respond.

Tim Goodacre is a Reconstructive Plastic Surgeon based in Oxford, with extensive experience of working in diverse environments outside the UK. He is immediate past Vice President of the Royal College of Surgeons of England.

Essay

Change

Community

Justice

15 May 2024

8 min read

Blackpool: how to make somewhere home

From tents to a town-wide regeneration, Blackpool’s hopeful placemaking.

John Clifton

John is a Salvation Army captain serving in Blackpool.

An aerial view at dusk of a brightly lit pier and promenade of the seaside town of Blackpool

Blackpool's piers and promenade.

“Good morning! Would you like to come in?”

I found myself in a local park. I’d had a couple of sips of my coffee, but it was still early in the morning on outreach in Blackpool with workers from the Council. The greeting from the man stepping out of his tent was a cheerful surprise. I was nervous as the task was to give the people sleeping in the small clearing behind the bushes a ‘heads up’. Enforcement action was planned, and a new Public Space Protection Order (PSPO)—another crude way to police the bodies of the unhoused who show up in places society doesn’t really want them—had been placed on the park. The Salvation Army and Council hoped to avoid, or at least lessen, any distress that a confrontation with enforcement agencies might bring about. However, sometimes the message can be confused with the messenger. Fortunately, my worries were unnecessary.

“You can get through here. Don’t worry, you won’t get muddy. We’ve made a path!”

He beckoned me and my colleagues to an opening. He had indeed made a path with some bark chippings. Giving us reassurance about the mud underfoot, he guided us to the space they had made home. The word ‘made’ is important here since they had shaped the space to become more habitable. This created the opportunity to welcome us and to show off what they had done. There was dignity in the orderliness of the space and an obvious pride in the landscaping. The message about enforcement was given with gentleness and received with grace. This grace, unexpected yet appreciated, was the day’s first lesson in humanity. My main lesson was realised only later, after we had bid each other farewell: that there is a deeply human and Christian call to transform spaces into meaningful places.

Just as birds intricately weave branches into nests and beavers architecturally sculpt their dams, we humans engage in this process to shape our environments to fulfil our needs.

Although living on the edges of society, those I met had carved out a small space to call home. They exerted control over it. What was previously space became place through personalisation, social interaction, and functionality. Human experience was layered there, changing the appropriate mode of analysis from geography to biography. Life was being lived. However, that place was to return to its previous anonymity. It would lose its distinctiveness, stripped of the layers of meaning it had for the short time it was inhabited. Although it may sound nostalgic, it's clear that for those living in them, the tents were more than a makeshift solution. They symbolised a deep need to create a home, even in the toughest conditions. Experiencing long-term homelessness, they saw the park as an improvement over the exposed town-centre shop doorways, fully aware, however, of the hurdles in finding a stable home. They looked at their time in the park not just as a stopgap but as a respite in the journey towards a better future, even though they knew it wouldn't be quick. Their plans clashed with the reality of enforcement agencies, whose actions focused on moving them on quickly.

Their attempts to carve out a place of their own in the park are an expression of an impulse indelibly woven into the human condition: the need to make our environment our own. Just as birds intricately weave branches into nests and beavers architecturally sculpt their dams, we humans engage in this process to shape our environments to fulfil our needs. This instinctive behaviour is also an inherent drive to mould our surroundings to reflect our identity. These acts of placemaking not only alter our immediate environments to enhance our quality of life. They also influence the broader ecological and social landscapes in which we dwell. Indeed, a PSPO is part of that broader social landscape. So too was our outreach. The reciprocal relationship between humans, habitats, and other humans highlights how our endeavours to create 'home' extend beyond mere physical modifications. They are the very fabric of our communities and ecosystems. By transforming spaces into places imbued with meaning and purpose, we participate in an ongoing dialogue with the world that shapes both our development as individuals and the collective evolution of our surroundings.

Stewardship goes beyond mere conservation, however, embedding a sense of responsibility to enhance communal welfare and well-being

It is a sentiment I know myself. Having frequently moved home in my youth, like many who search for a place to belong, I am acquainted with the need to craft home anew. As a child, it was putting up familiar football posters on my bedroom wall. As an adult, it is a reshuffling of the living room furniture, which my wife graciously accepts. Intriguingly, my grandmother, whom I know only through stories as she died before my birth, shared this ritual of rearranging her lounge. It is a compelling idea that such behaviours might form part of our genetic makeup, passed along generations, silently teaching us habits to create home. Perhaps this impulse is heightened by my dwelling not being my own but rather a provision by The Salvation Army to fulfil my commitment as a Salvation Army officer. This rearrangement ritual becomes a prayer in action, making space into place again. It is a home not owned by me but held in trust, reminding me that my role in the community is both temporal and purposeful, and my residence a testimony to service over possession.

In Christian thought, there has always been a strong emphasis on caring for the environment, a practice often referred to as "stewardship." This concept is rooted in the belief that all people are caretakers of the Earth, entrusted to foster and preserve the natural and social environments in which they live. Stewardship goes beyond mere conservation, however, embedding a sense of responsibility to enhance communal welfare and well-being—what in Hebrew is called shalom. Shalom encompasses more than peace; it implies a holistic harmony that includes justice, well-being, and prosperity. In practice, this means Christians are encouraged not just to inhabit spaces but to actively improve them, ensuring they contribute positively to the community. This desire to contribute to the fulness of human experience expressed as shalom underscores the dual nature of Christian and, fundamentally, human existence: engaged, yet expectant; grounded, yet yearning for a true home.

The mission of placemaking knows no bounds: from the local county to the national landscape, and even the global stage.

Placemaking is about transforming both individual spaces and entire communities, such as towns and cities in need of rejuvenation. An example of such transformation is seen in Blackpool, a town with a rich history, now on the brink of significant change. The Blackpool Pride of Place Partnership, formed seven years ago, underscores this through its recent event at the Blackpool Tower Ballroom, launching the Town Prospectus for 2024. This event showcased the combined efforts of both the private and public sectors to achieve their shared goals. The latest prospectus highlighted the progress from mere ideas to tangible achievements. Much like the pride the unhoused man showed in his makeshift chip-wood path, it highlighted with rightful pride the transformation of concepts from the initial prospectus—once mere computer-generated images—into tangible buildings and projects now existing in reality. This larger-scale transformation reflects a universal need to adapt our environments for the better, mirroring the individual acts of placemaking, like those seen in a morning outreach in the park. The practical challenge is how the instincts and dreams of the unhoused man, currently manifest in a little bark footpath, might be better translated into the wider process of town-wide identity. This process often leaves even the most engaged people feeling overlooked, especially those trapped in the cycle of homelessness, unable to see beyond immediate survival. It is here that the Christian community gets involved in this placemaking.

Just as the church will be called to extend support to a person without a home, we are similarly obliged to play a role in the broader scope of regeneration efforts by helping the voiceless find their voice and amplifying it. Our stewardship extends beyond mere occupation of space; it is a call to play a bold role, engaging confidently and constructively with decision-makers and policy-shapers to help resist the secular tendency towards inequity. The Christian’s vocation to sojourn purposefully intersects with a civic duty to nurture spaces that promote the well-being of all residents, but with a particular bias towards those who are voiceless. In the context of Blackpool, invoking the spirit of Jeremiah we are urged to ‘seek the shalom of Blackpool... and pray to the Lord on its behalf, for in its shalom you will find your shalom.’ This noble endeavour to move the ‘World As It Is’ to the ‘World As It Should Be’ is transformative. It not only reshapes our communities but also refines our own character from ‘Who I Am’ to ‘Who I Should Be’. This fusion of spiritual odyssey and community involvement epitomises Christian discipleship. Placemaking, then, can be an act of faith and dedication, not merely shaping physical landscapes but also weaving a spiritual fabric that enriches the collective identity of our communal life by including those on the edge, like people in tents in a park.

This principle transcends the specific context of Blackpool. The mission of placemaking knows no bounds: from the local county to the national landscape, and even the global stage. The shaping of space into home is a fundamental instinct relevant to all, from an unhoused neighbour to residents of a town like Blackpool to the Christian sojourning in the world. The church has an invaluable role to play in this effort, serving as both a consistent presence in a place undergoing upheaval and being a catalyst for change, but most particularly an avenue for participation for those we might consider to be ‘the least of these’ - the homeless man; the battered girlfriend; the addict; the asylum seeker; the kid excluded from school; the lonely older person. By embracing this call, the church upholds its commitment to being a faithful community and fostering belonging. It also participates in the divine act of creation, shaping the world to reflect God’s love and grace. Through this sacred duty, the church contributes to spaces becoming places of shalom. Indeed, without ‘the least of these’ playing a part, true shalom is not possible. By partnering with other local organisations through broad-based community organisations, initiating housing projects, or advocating for policy changes, the church can materialise its vision to make earth a bit more like heaven. Examples from communities where churches have led or participated in urban regeneration efforts demonstrate the transformative power of faith in action, turning spaces of neglect into thriving places of community and support.

From the personal touch of a man creating pathways in a park, to my relocating of household furniture, to the communal efforts in Blackpool's regeneration, we witness a profound truth: that shaping our world to become home is not just an act of physical transformation but an expression of deep spiritual yearning, which is, fundamentally, to know that the Kingdom of God is among us.