Paula Tobin is a senior NHS nurse in Plymouth. After serving in the British Army, she has worked in emergency departments for 25 years and has previously deployed to Ukraine and Türkiye with UK-Med. She recently returned from her second deployment to Gaza, where she witnessed the rapidly deteriorating humanitarian situation.
Somebody told me in Gaza, ‘the world watches.’ I’ve thought about that a lot since coming home. How many more people have to die before the violence ends? What more is left to take from them?
I could offer few words in response, other than to say that people still care – we still care – and that they deserve as much help as anybody else.
That short exchange was during my second deployment to Gaza. I’d arrived hoping, maybe naively, that the situation might have improved since I first deployed in March. In a sense it had; the field hospital in Al Mawasi had been expanded. Extensions to the maternity unit and emergency department had been bolted on and a new operating theatre, housed inside a shipping container, was added.
The hospital was functioning well, and it was my job, as the Hospital Lead, to ensure it ran smoothly and kept pace with the hundreds of patients that arrived at the blue gates each day in need of healthcare.
But while the hospital itself was running well, we quickly ran into problems. Getting equipment, medications and consumables was difficult. We soon ran out of gauze which we needed for surgery and resorted to cutting up bandages to use as swabs. Other times we struggled to get the right antibiotics, and we had a scant supply of crutches and wheelchairs for the amputees on our ward.
Then of course there was the gunfire and shelling. The ‘frontline’ if you can call it that, had moved closer to us. In March, we were living in a building to the south, in Rafah, but now we were sleeping in tents on the hospital grounds. The team were forced to abandon Rafah as the fighting moved northward, leaving the old house outside the ‘humanitarian’ zone. The fighting was closer, and you could feel it.
The United Nations say that 86% of the Gaza Strip is under evacuation orders or designated “no-go” zones. 90% of the population have been displaced at least once.
The sense of fear and desperation ran deeper now; there was an air of unease. Packed into close-set lean-tos and tarpaulin tents that trapped the summer heat, people were hot, desperate, and scared.
Within the four walls of our hospital, it was even more important to maintain a calm environment. If you stay calm – and this is much like working in an emergency department – then everybody falls into that feeling with you. Panic, and the whole thing falls apart.
Our calm was put to the test during what are euphemistically called mass casualty incidents. Usually this would be an airstrike, of which there are many, resulting in dozens of deaths and several times as many wounded. We had to be ready in minutes to receive a large number of dead, dying, and injured.
The ambulances would dart out of the hospital and return with three or four people in each, offload their casualties, then quickly drive off again to collect more. Prehospital intervention was minimal – these were very basic ambulances you see – so a lot of people had only been bandaged before they were put in the back and delivered to our emergency department.
I remember one case very well. Not far from the hospital, a wave of people were fleeing from a military incursion they didn’t expect. A swathe of tents was being abandoned as people ran from the approaching gunfire. As expected, a fleet of ambulances pulled into the hospital and in the back of one of them was a little boy, about four or five, all on his own.
He was completely uninjured; he had climbed into the back of the ambulance to get away from the danger and had been separated from his family in the mayhem. We didn’t even know if his family were alive.
We gave him a bed on the paediatric ward overnight and the next day the team put out a call to the community saying that this young boy was with us. Soon after, his father showed up at the hospital. The boy’s mother had been shot – but was alive – and the father had been terrified that the poor child had been killed in the chaos.
This war is terrifying for children. I wonder where they’re going to be in ten years’ time. They’ve seen things that no child should ever see. The have no homes, no education, their nutrition is suffering, and all the while they’re witnessing such horrendous things.
People in Gaza are exhausted. They’re trying to survive one day at a time. After all, how do you plan for a future if you don’t know you’ve got one?
Having deployed twice to Gaza, I can’t believe it’s gone on as long as it has. These are normal people who want to live normal lives. They want to feed their children, run their household, go to work, earn money, see their friends. But now, they’ve lost everything. From one day to the next, they wonder am I going to be alive? Are my children going to be alive? What about my parents? I don’t know how much longer they can put up with it.
There was a very kind man at the hospital, a nurse on one of the wards, and all his family were killed - all of them – in a single strike while he was working a night shift. But the local staff still show up to work. Their strength is incredible, but it shouldn’t be tested this far.
I’ve worked on other humanitarian responses where there was a clearer start and end; a flood of aid at the beginning, after which a sense of normality was restored. That’s not the case in Gaza. Going into a response, there should always be an exit strategy, but how can you have an exit strategy if you don’t know when it’s going to end?
