“I’ve done over 20 responses with UK-Med, but I’ve rarely ever seen destruction of this scale.” David Anderson, Senior Health Advisor for Disaster and Conflict Response at UK-Med, recently returned from Gaza where he helped build a field hospital from scratch.
David played a leading role in the construction of the UK-Med field hospital, which provides vital primary healthcare for conditions such as asthma, diabetes, and heart disease. With plans to soon scale up the existing field hospital to provide surgical support to treat major traumatic wounds, David looks back at how the hospital started, when his small team made the bold decision to build a hospital in a conflict zone.
It began in December, when UK-Med asked if I could travel to Gaza to help set up what we expected would be a major humanitarian response.
Following a fairly new route with the UN, our team entered Gaza via the Rafah crossing. Immediately, what struck me was the level of destruction. I’d only ever seen that before in small pockets of Ukraine, whereas in Gaza, the destruction was everywhere. It was clear that our response would have to be huge to meet the scale of need.
To help us meet that need, we had the right permissions to get our tented field hospital into Gaza, but we knew it was going to take a long time. Meanwhile, the demand for medical aid was continuing to grow at an alarming rate and frankly, the tented field hospital wasn’t going to arrive quickly enough.
We said “We need to respond, and we need to do it now. How do we do that? Well, we build our own facility of course, and we start treating patients as quickly as possible.”
After a short discussion with the team, we decided to build it using whatever construction materials we could find in Gaza, with the idea being that the tented field hospital -which was on its way from Manchester – would add to it, expanding our provision of healthcare. The tents we didn’t use, we would keep back and quickly deploy as clinics as and when needed as the conflict ebbs and flows.
Even with a makeshift hospital, the standard of medical care we could provide was a lot higher than what people in Gaza had before – which, due to the impact of conflict, was nothing. At least we could give some privacy and some dignity for the patients and a place to receive treatment in a designated space.
Of the 36 hospitals in Gaza that once provided medical services for more than two million people, only 10 are still partially functional according to the World Health Organization (WHO).
A huge challenge in a very complex environment
The first question was, where were we going to find space for a field hospital in the middle of Rafah, with 1.5 million displaced people? That itself was a big problem.
But even once we found the space, there were even more factors to consider. Could we get power to it? Could we get water? How were we going to get the medical equipment we needed? What about fuel for the generators?
It was a huge challenge in a very complex environment.
After a lot of debate among the team about design and how to manage the flow of patients in and out of the facility, we immediately set to work gathering whatever materials we could from the surrounding area.
Finding the right stuff required a combination of two things; seeing what we could buy on the local market without heavily impacting the availability of materials in Gaza, as well as leveraging our connections with other NGOs and UN Agencies to procure whatever medicines and equipment we could get our hands on.
Ideally, we didn’t want to buy a load of materials on the market if we could avoid it. There are 1.5 million internally displaced people in Rafah. They’ve lost their homes and they’re trying to build shelters for their families from the same wood and plastic that we wanted to build a hospital with. Naturally, we were reluctant to take a huge amount of those materials for our own purposes, even if it was to build a hospital to provide healthcare for the community. So, we would buy what we knew wouldn’t be used or needed, and supplement that with supplies we were able to get from other sources.
And that’s where our connections with other humanitarian organisations came in handy. Gaza is such a challenging context to work in that very few organisations are operating there, particularly medical NGOs. The needs are enormous and frankly, there’s too much work with not enough people or equipment to do it. That means that many NGOs are trying to support one another, in whatever way they can. In my ten years of working in the aid sector, this was the most collaborative humanitarian response that I have ever seen.
UNICEF said to us, “We have supplies in our warehouse, do you want to come and have a look? And of course, you can have it for free.” UNFPA said, “If you’re providing maternal healthcare, we have all of these kits coming in – do you need some?”
Piece by piece, we built up stocks of medicine, acquired the equipment needed to run the clinics, and sourced the raw materials to build the physical structures. We levelled the land, took some plastic sheeting from UNICEF and some old timbers from a damaged building and set up the beginnings of our field hospital.
Ordinary, lifesaving health care
Currently, the field hospital isn’t yet able to see patients with major trauma or very complex cases, mainly because of a lack of equipment; a lot of the medical kit that was in Gaza before the war has been used or destroyed. We’re urgently trying to get equipment into Gaza, but it’s proving difficult.
However, the team are still providing primary healthcare at the field hospital, which is equally important. People still need appendectomies. People still need treatment for asthma. People still have heart attacks. All those cases happen alongside the trauma work we usually see in a war zone.
It’s equally as lifesaving to treat a person with cardiac arrest as it is doing complex surgery on a polytrauma patient.
We shouldn’t lose sight of that kind of medical care, and that’s what our field hospital is capable of providing at the moment.
Everything from diabetes to chronic disease management still needs to be treated in a conflict zone like Gaza. And, of course, if you stop getting the medication for your hypertension or your diabetes, you’re at risk of all sorts of things going wrong: your chances of having a stroke or a cardiac arrest are hugely increased by not having the appropriate treatment.
The plan, of course, is to have the capacity for more major operations and to deliver that to as high a standard as possible. Which we will do once we manage to get the necessary surgical equipment into the field hospital. But even if the conflict ends today, the health system in Gaza won’t be rebuilt in a year, or even three. It’s going to be a long process. Many hospitals have been completely destroyed, and with that scale of destruction, there are medical procedures that still can’t be done – where do you for a caesarean section, for example? All the beds in the hospitals are occupied by trauma patients. Being unable to access that kind of care can put the lives of both the mother and child at huge risk.
In that context, there’s a place for field hospitals like ours to provide ongoing support. The number of trauma patients will hopefully begin to decrease as the conflict wanes, whenever that may be. And we’ll continue to support people needing simple but essential procedures until Gaza’s health system recovers to some semblance of what it was before.
To support and expand our medical work, we have launched our Gaza Health Crisis Appeal. Please consider donating today.
