Haaretz
Nasser Hospital’s emergency room in the southern Gaza Strip has a special area where children are allowed to die quietly in the presence of their families. Known as the ‘dead children’s area,’ it’s also for children whose rescue would require resources beyond the hospital’s means.
On the night of March 18, when Israel violated the cease-fire and resumed the war in Gaza, Dr. Feroze Sidhwa sent two girls to this area.
Sidhwa, who lives in the United States, arrived in the Strip in early March to volunteer for the second time. That night, he slept in the doctors’ room on the fourth floor of the hospital.
At 2 A.M., the door was violently blown open by an airstrike nearby.
‘We woke up and for a minute we just sat there. … After the bombs kept going off for about five or six minutes, we said we better go down to the emergency room,’ he says.
Over the past year and a half, the staff at Nasser Hospital in Khan Yunis has gotten used to mass casualty events. According to protocol, a young Palestinian doctor is stationed at the hospital’s entrance.
‘That person’s job is to send them straight to the morgue,’ Sidhwa says. ‘Families will want somebody evaluated even if their head is cut off. But it’s very, very hard to do that with children, especially small children like 3-, 4- or 5-year-olds. It’s very hard to send them directly to the morgue.’
After the strike at 2 A.M., Sidhwa says ‘for the first, like, 10 or 15 minutes, all we did was pronounce small kids dead because … in a mass casualty event, you have to prioritize people who are the most likely to live.’
Sidhwa admits he declared the two girls dead early. Given the conditions at the hospital, there was no chance to save them.
‘They both just had terrible brain injuries. … So I had to just tell their families, I just had to pick them up and say, ‘They’re going to die, there’s nothing I can do about that.’
Sidhwa says the hospital staff set up this area ‘because they have a lot of experience and they knew that this scenario would happen.’ Priority must go to those who might survive.
Everything that the U.S. and Israel are doing to Gaza is tailor-made specifically to undermine human health. Making people live outside, not letting people eat.
Dr. Feroze Sidhwa
‘The first child I saw was a girl about 3 years old who had shrapnel everywhere on her face, on the back of her head, just everywhere,’ he says, adding that part of her brain was exposed and one of her eyes was totally destroyed.
Several things had to be taken into account, including the fact that the hospital had no neurosurgeon. ‘The only neurosurgeon in the south of Gaza is at the European Hospital. So even if we could have saved her with neurosurgical intervention, we didn’t have that, so there was nothing we could have done there,’ Sidhwa says.
‘The second thing is that I could have put a breathing tube down her throat, I could have used the ventilator to breathe for her and I could have given her IV fluids. I could have put an IV in her and all of that would probably have kept her alive for 24 to 48 hours while her brain died. Once her brain died … her heart would have stopped over the next few days.’
‘If I do that, I’m spending close to an hour saving somebody that I know is going to die anyway and I’m not doing something to save somebody else.‘
‘So I picked this girl up, handed her to the guy that was with her and said, ‘Look, she’s going to die. Take her to the dying children’s area.’
The second girl, who was 5, also suffered a brain injury from shrapnel. She too was handed over to her parents in her final moments.
Around that time, another American physician, Dr. Mark Perlmutter, was volunteering in the Strip. He worked at the small Shuhada al-Aqsa Hospital in Deir al-Balah in central Gaza.
He says that in mass casualty events ‘there’s blood everywhere. The floor is covered with blood. Your feet slip on blood. One person could be squirting blood on another person next to them.’
According to Perlmutter, many of the wounded need amputations to save their lives. Sometimes they arrive with tourniquets on all four limbs, or with an open head wound exposing their brains.
Perlmutter lives near Raleigh, North Carolina, at the constellation of Duke University, the University of North Carolina and WakeMed – three different teaching hospitals and even more trauma centers, which he says would be paralyzed by the situation he witnessed in Gaza.
Perlmutter sent Haaretz dozens of photos he took in Gaza. Very few can be published. They show children with mangled or severed limbs, dead children, floors covered in blood and body parts, a table piled with small bodies and half a body lying in the street.
Sidhwa, a trauma and general surgeon in California, is the son of Pakistani parents, members of Pakistan’s Zoroastrian minority. Perlmutter, an orthopedic surgeon, is the son of a Jewish father and a Catholic mother.
Both have a long history of volunteer work after disasters; Perlmutter has treated victims after 9/11, Hurricane Katrina and the 2010 Haiti earthquake, to name just a few. Sidhwa assisted after the 2013 Boston Marathon bombing and in Haiti, Zimbabwe, Burkina Faso and three times in Ukraine, with his most recent stint in October 2023.
Both are back in the United States. In Zoom interviews, they agreed that the disaster in Gaza can’t be compared to any natural or man-made catastrophe of recent decades.
‘Hamas exists as a military wing because the Palestinians don’t have freedom,’ Permutter says, adding that the Gazans he met don’t hate Jews. Sidhwa adds: ‘If anything, stopping the war in Gaza is the only way Israel will survive, at least in any kind of recognizable way.’
We would step over kids – and I knew that I could save them in the United States – just to look for a kid who had a better chance of surviving.
Dr. Mark Perlmutter
Permutter: ‘And if Israel doesn’t want people to revolt against living in an occupied state, then give them their damn freedom and Hamas will disappear.
‘And there’s proof of it. … Look at Ireland. The country that’s protesting Israel’s behavior more than any other, with the exception of South Africa, is Ireland. … Twenty years ago there was a militant group called Sinn Fein. And Sinn Fein today is a political power in Ireland.’
In October, Sidhwa and Perlmutter signed a letter to then-U.S. President Joe Biden demanding the cessation of arms transfers to Israel. The letter included severe accusations against the Israeli army, including the shooting of Palestinian children.
Sidhwa reiterated these claims in a New York Times op-ed based on X-rays of children wounded by snipers’ bullets. When some readers questioned the claims and images, the newspaper investigated with the help of independent experts.
‘We stand behind this essay and the research underpinning it,’ The Times’ opinion editor, Kathleen Kingsbury, wrote in a response. ‘Any implication that its images are fabricated is simply false.’
Sidhwa and Perlmutter also volunteered in Gaza a year ago. ‘When we entered Gaza, we smelled the sulfur of decaying bodies, the sulfur of sewage and the sulfur of gunpowder. … It set the tone for what we started seeing immediately when we got there,’ Perlmutter says about his first visit.
‘Within hours, our first mass casualty event happened. And when I say mass casualty event, I mean enough shredded people came in that would overwhelm any major city’s trauma centers.’
He says that in his first week there, he performed more metal implant surgeries than in his previous 20 years as a surgeon.
During his first visit to Gaza, Sidhwa volunteered at Khan Yunis’ European Hospital, which was overwhelmed. Hundreds of displaced Palestinians took refuge there, while thousands more camped around it, hoping the Israeli military wouldn’t strike the facility.
The sanitary conditions were horrendous. ‘In that time, I lost 15 pounds [6.8 kilograms],’ Sidhwa says. ‘I had diarrhea and a cough the entire time, and so did literally every single person I was with.’
Both doctors agree that Gazans’ health was significantly worse during their second visit. ‘Everything that the U.S. and Israel are doing to Gaza is tailor-made specifically to undermine human health,’ Sidhwa says.
‘Making people live outside, not letting people eat, destroying Gaza’s food production system … [and] the things that societies value, housing and education. These are all things that make human health better. And when you take it all away, people get really sick.
‘Virtually everyone in Gaza is homeless. … And in the U.S., we can show very easily that just being homeless creates a huge number of problems for you.’
Perlmutter adds: ‘When I walked between Nasser and Amal [Hospital], just to see what it was like, there literally wasn’t an undamaged building. … Maybe a fourth or a third of the buildings were just completely destroyed, like completely collapsed or just so beyond damage that only a nutcase would try to go inside. I don’t think I saw a building that had all four of its walls intact.’
Then there’s the food shortage. Sidhwa and Perlmutter say the entire Gaza population is suffering from a severe deficiency of vitamins and protein.
‘I ate meat once on March 6th, the day I got there,’ Sidhwa says. ‘And then we got chicken – I think it was March 25th or 26th. In between that time, I literally ate only rice.
Perlmutter adds: ‘A can of tuna fish is a week’s salary, right? A tomato. Two tomatoes are a day’s salary. Four beets are a day’s salary. There was pita bread and there was hummus.’
The two say Nasser Hospital – currently the largest functioning hospital in Gaza – is significantly better equipped than Shuhada al-Aqsa. Perlmutter says Shuhada is constantly short of equipment, medication and other essential supplies.
‘I brought soap to wash my body and my hair – little tiny hotel bar soap,’ he says. ‘I used that to wash my patients’ extremities. I used my own mouthwash to disinfect a wound before I made an incision on it.
‘And there are no antibiotics and no pain medicine. Zero pain medicine. Can you imagine losing three limbs and waking up from anesthesia with no pain medicine? … People just screaming all day long?’
In one case, Perlmutter was forced to leave a surgical drill inside a patient’s leg because he had run out of the screws to secure the bone.
Sidhwa also reports shortages of medication, blood units and equipment, though not of the essential supplies needed for trauma care. During his first two weeks in Gaza, before the fighting resumed, he mainly treated people injured in building collapses; often they were trying to recover bodies from the rubble.
And about once a day, someone arrived with a different kind of gunshot wound, courtesy of an Israeli sniper at a tower on the Philadelphi corridor on Gaza’s southern border.
From March 18 until their departure from Gaza, Sidhwa and Perlmutter canceled all scheduled surgeries and focused solely on saving Palestinians wounded in the bombings. They say that when a bomb hits the dwelling of a displaced family, dozens of wounded can arrive at the emergency room within an hour. The operating rooms can’t keep up, and many people die in the emergency room or hallways.
‘Many of the people who were waiting to get into the operating room died before they got there. We would step over bodies, even children,’ Perlmutter says. ‘We would step over kids – and I knew that I could save them in the United States – just to look for a kid who had a better chance of surviving,’ he adds, his voice cracking as he tears up.
‘I have nightmares every night. It started off as kids reaching out to me that I’m stepping over to get to another kid who could live. Reaching out and pulling on my pant leg, asking me in English, ‘Please don’t step over me, please help me.’ I have other ones telling me to help their sister next to them.’
The two doctors say that, as in their previous visits to Gaza, many of the dead and wounded from Israeli strikes are children. ‘Of 70 people every hour,’ Perlmutter says, ’40 are going to be children.’