The human cost of the Israel-Gaza war

A veteran volunteer surgeon laments a well lived life.

Tim Goodacre

Tim Goodacre is a reconstructive plastic surgeon, and volunteer at a hospital in Gaza.

AbdulRahman at work.

Tim Goodacre.

The Israel-Gaza war rages on. Every few days a new tragedy hits our dulled senses. The West Bank and now Lebanon are getting dragged into the conflict. Palestinians and hostages continue to die, and hunger and disease threaten Gaza's displaced people as autumn and winter approach.

Yet what is often lost is the human face of this conflict. This is the story of one such life.

AbdulRahman was an intelligent, gentle and diligent young third year medical student in his early twenties, with judgement well beyond his peers. Towards the end of 2023, as the war spread more viciously towards southern Gaza, he was one a group of around 10 students who volunteered to join the team of health care workers at the European Gaza Hospital (EGH). I was volunteering there as a reconstructive plastic surgeon and and met him in the hospital.

Both medical schools in Gaza before the war began were in the north alongside their parent universities. They had been destroyed during the onslaught in the early months of fighting. In the southern town of Khan Younis, the EGH was the sole surviving operational facility to which the wounded could be transferred. It was overwhelmed by the vast numbers of families also taking refuge in what was deemed a safer space than most of the surrounding war zone.

Many of the senior medical staff and surgeons had retreated to scattered parts of the strip, displaced frequently by the ever-moving conflict and driven by the need to support their families and stay together. ‘Live together-die together’ is an understandable feature in the horror show of war. Students, frequently left with no money or resources, started to volunteer to serve in hospitals in exchange for a little food and a sense of worth in the work they could offer. Any functioning hospital, if briefly ‘deconflicted’ so they could provide relatively safe care, found itself staffed by a disparate crew of local staff, displaced students, and an indeterminate number of more senior surgeons from both Gaza and humanitarian agencies.

His desire to learn all that could be learnt, and to try to become the best surgeon possible, was palpable.

It was into this chaotic mix that young AbdulRahman walked having fled his family home in the east of Khan Younis in November 2023. A bright young man, with great aspirations to qualify as a surgeon and serve his community, he had spent the first six weeks of the war at home, unable to attend his medical school in Gaza City to the north, but working hard at his studies regardless, using every online and library resource available to him.

At some point in late November, the battle zone moved south, and his family home was shelled along with many dwellings in the vicinity. Caught in crossfire, he sheltered in his neighbouring relative’s house after his parents and other close family had escaped to Rafah.

Abdulrahman told me the dramatic story of his escape into the house in which he survived for a week alongside his relative’s family when I spoke to him in late January 2024. This young man not only survived an ordeal of indescribable fear and potential slaughter, but he was then arrested and interrogated in brutal fashion by IDF forces.

On his release after a harrowing week, he made his way barefoot to the nearest hospital, which happened to be the EGH. In that place of safety, he was given food and water and after recuperation, volunteered to work alongside a reconstructive plastic and burns surgeon who had recently returned to Gaza after training in the UK.

Although his family were still all alive in Rafah in displaced makeshift shelters, he opted to stay and throw his weight into whatever he could do to support the hospital whilst continuing to learn his profession as a doctor. Travelling occasionally at great personal risk to see and support his family, he devoted all his waking hours to surgical work in EGH operating theatres and wards. His excellent command of English made him immensely valuable to any visiting surgeons who managed to access Gaza during the war months. He was always cheerful, always willing to respond to requests for his time, however stressful the surrounding clamour from desperate patients and relatives might become.

When his working day was done, in the middle of the night he would arrange for his fellow students to have informal teaching seminars from whoever he could cajole to deliver them, and would absorb knowledge and ideas about best practice like a sponge. His desire to learn all that could be learnt, and to try to become the best surgeon possible, was palpable.

I had every intention of supporting this fine young man in achieving his professional aspirations by whatever means I could once a ceasefire arose and he could be brought safely to Europe to continue his training.

In the last week of August, AbdulRahman was sheltering in a relative’s house in Khan Younis. In the small hours of the morning an Israeli attack was launched on the neighbourhood and the house took a direct hit. AbdulRahman was killed instantly.

He knew, as does every Gazan in these troubled times, that nowhere was safe, and all lives in that tragic zone are at risk. His is a story of a life tragically cut short, of the randomness and destructiveness of war. His death strikes right at the heart of my hopes for the remnant of the fine young population of such a desperately sad nation state. He, and those like him, could have been at the heart of the re-building of Gaza, able to live in what now feels a far-off peace. I cannot translate this into anger, as AbdulRahman himself had a passionate concern for peace and reconciliation, and never once spoke to me in many conversations of support for Hamas, or of hatred for those who had destroyed his country.

What can be done however, is to honour his life and commitment with similar tenacity in supporting the pursuit of peace, justice for his people, learning and education for the remnant of the nation, and reconstruction of a Palestine that can proudly and honourably reflect the finest values it possesses. AbdulRahman was a great Palestinian, and his all too short life was one which I want to celebrate as one of the finest I have seen in many students of the next generation of doctors. May he rest in peace, and may a lasting peace come quickly to Gaza, to all of Palestine and the whole of the Middle East.

Article

Awe and wonder

Comment

7 September 2023

6 min read

The heart of the matter

Heart doctor Michael Henein steps back to consider the unseen and unique wonders of the human body’s design.

Michael Henein

Professor Michael Henein is a consultant cardiologist, and a Professor of Cardiology at Umea University, Sweden.

A model of a human heart on a short stand.

Photo by Jesse Orrico on Unsplash.

Shakespeare famously asked:

“What a piece of work is a man, how noble in reason, how
infinite in faculties, in form and moving how express and admirable, in action how like an angel, in apprehension how like a god! the beauty of the world, the paragon of animals—and yet, to me, what is this quintessence of dust?

Humans may be complex, capable of great heroism and deep depravity, yet it is worth stopping for a moment to look at the human body and mind to marvel in what we have become, and how we are made.

The visible design of the human body points out common features shared along with other members of the animal kingdom. Examples of these features are: two eyes, two ears, two nostrils, one mouth and four limbs, attached to a body and head. Detailed study of different seen parts of the body may, however, show some differences. For example, the presence of fingers and nails, hair distribution as well as a developed tail. While most members of the animal kingdom have teeth and a tongue, those two could also vary in their number and size, respectively, according to different species. Genetic investigations have shown that we humans share 99 % of our genes with animals, suggesting that our “earthly” component shares a common origin. Indeed, the twenty first century scientific findings match what is written in the Genesis story of creation, a story written over 3,500 years ago, well before genetic sciences came to light.

Creatures great and small

As for morphological differences between animal species, it is difficult to naively conclude why some are wild while others are man-friendly-even if the wild ones have different shapes, design, dietary habits, body size and life span. Other important observed features of the members of the animal kingdom are that they are all born, they all age, then ultimately die.

If we are to look at the unseen features of the members of the animal kingdom, we can again identify similarities. For example, all have a gastrointestinal tract, a cardiovascular system, a reproductive system, a respiratory system, a urinary system and much more. While these systems may differ slightly between species, the overall structure and function achieve similar purposes. For example, heart speed is faster in small animals like rats compared to big ones like elephants who have very slow hearts. Likewise, the respiratory system and the number of respiratory cycles per minute are significantly faster in running animals compared to the sedentary and slowly moving ones. Finally, the number of offspring also differs in different species, being just one at a time in big animals like elephants and horses, and many offspring in small animals like rabbits and mice. Such paradox between the number of offspring and animal size makes you think of the important determining role of the activity of those animals.

Unseen wonders

Now to turn to the rest of the animal kingdom and the unseen features of the human body. To start, let us look at the amazing functions of the human brain and its various functions. When humanity is sometimes described as the crown of creation, such a description is based on the superiority of human brain function and skills. Its sophisticated structure and how vital centres are created deep in the skull, to be protected from traumas, make you marvel. Also, the brain controls the different functions of the whole body, with its sensory and motor activities, various vital system functions including the lungs and the heart, all endocrine glands’ function, in addition to various receptors and centres that allow utmost precision and accuracy in everything we do. An example of this kind of precision is a doctor feeling a vein or an artery with the tip of a finger to insert a needle or a musician moving a finger a few millimetres while playing a violin, to produce the exact sound needed. Furthermore, the integrated function of human muscles, nerves and spinal cord is also amazing, let alone the synapsis between the nerve endings and muscle bundles, the chemicals secreted in them which allow electric stimulus transmission from the nervous system to achieve the motor function and desired movement.

The human brain also has the unique feature of storing knowledge. Of course, we should not ignore the importance of the training and programming ability of human brain. We learn how to drive a car, how to play games, how to study, how to operate safely on a sick patient. Such acquired skills are quite limited in other members of the animal kingdom. Moreover, the human brain has the unique ability to invent, discover, improve and correct errors it identifies.

Another very unique feature of human brain is its ability to conduct speech, a feature of humans that is under-developed in other members of the animal kingdom. While most animals can make noise and sounds, only humans can articulate words, sentences and even sing very complex songs. This unique ability seems to be the underlying mechanism behind the development of languages which are based on the human ability to talk and transmit information and knowledge by words and phrases.

The unseen brain has allowed human life to develop over time, building skills and achievements from generation to generation. Millennia ago, humans lived in huts together with animals, and now they build houses and palaces to live in. Centuries ago, we used donkeys, horses and camels to travel but now we use cars, trains, ships and airplanes. Our ancestors burned wood and coal to cook and to warm but now we use electricity to do these.

When we look carefully at the unseen parts of the human body, we also realize that we cannot alter any of it, despite the scientific advances made over the years. We can understand what harms our body and take measures to avoid it. Out of the ability of our brain to discover and invent, we have now produced science-based means for curing various diseases. Consider how we can replace a dysfunctional heart valve or a mobility-limiting joint. These inventions have resulted in a better quality of life, alleviating of symptoms, even helping to avoid early death, in some cases such as heart disease and cancer.

The heart of the matter

Another unseen source of life in humans is the heart. This fist-size organ is so complex in its structure and function. Recent scientific advances have enabled us to study heart function in milliseconds, hence the development of pacemaker treatments. They have also allowed clear imaging of the inside of the heart and the identification of pathologies, developments that guide practitioners to the optimum treatment of heart conditions. Recent discoveries have also allowed us to better understand how people develop coronary artery disease and how the pathology starts at the innermost layer of the arteries, particularly in individuals carrying significant risks for atherosclerosis including, smoking, high blood pressure, diabetes, high cholesterol and obesity. Amazingly, obesity has been shown to be the strongest underlying cause of other risk factors, hypertension, diabetes and hypercholesterolemia. So, nature cannot be blamed in many of these patients but our own patterns of behaviour. Science has shown that walking at least 5,000 steps each day, complying with the design of our body, reduces the likelihood of developing coronary artery disease by 15 per cent.

The unseen physiology of the rest of our body systems and the interaction between systems make us wonder how we are made. A rise of our body temperature by one degree due to a bug infection affects all body systems from the brain to the heart. A virus which cannot be seen by the most powerful microscope can destroy our lungs and cause premature death, as was the case with COVID-19 and others.

Finally, human inventions in the form of powerful microscopes have allowed scientists to study the human cell, which is the smallest living component of our body. Such small cells cannot be replicated in any factory in the twenty-first century, despite the vast scientific developments that surround us. You'll be surprised to learn how complicated and meticulously fine-tuned a human cell is and also how it functions, connects with other cells and other parts of the body. An example of this is the interaction between body minerals, calcium, sodium and potassium with heart and muscle individual cells. Such a function is critically controlled by many factors such as time, electric stimulation and pressure differences producing remarkably harmonious contractions and relaxation of the muscles without missing a beat.