GRM is part of a multi-aid response team providing trauma and emergency medical care in Gaza. The following is an excerpted version of our team member’s situation report for the eight days he spent in Gaza in February 2024. This is a firsthand account from the front lines.
Situation Report – Gaza Mission
Day 1
Arriving in Rafa, we are part of a multi-organization team, which includes 1 team lead, 1 tech/logistics/security specialist, 2 doctors, 2 nurses, and 2 paramedics.
While the medical team was unloading containers and bags, the team lead and security specialist made a quick site survey to designate primary and secondary exit points and sheltering options.
Overnight there was heavy bombing from the sea and air across southern Khan Younis areas. You can hear large-caliber gunfire from the helicopters, small arms fire, and drones circling the enclave 24/7.
Day 2
0800 – Our team lead and I attended our first UN cluster meeting at the Joint Humanitarian Operations Center (JHOC). The meeting provided initial introductions, networking connections within the Health Cluster, as well as a general context of specific operations and actions taken by other NGOs and agencies.
Back at the guest house, I gave a security briefing and a rundown of P.A.C.E. protocols, as well as making sure each team member had and was familiar with their individual first aid kits (IFAKs are the kits team members carry to treat themselves in the event of injury).
Around 1000, our team moved by car to the TSP (trauma stabilization point). We worked alongside the local medical teams handling a variety of traumas most of which were gunshot and shrapnel wounds, fractures, blunt injuries, and burns, some of them 2-3 weeks old. Patients were both women and men. Some patients with chronic illness from pre-existing conditions arrived during this period but we referred them to a primary healthcare clinic just a few hundred meters away where a steadfast group manages cases of general healthcare and acute injuries.
The ability to treat and transfer patients is very dependent on the level of fighting and access to where patients are originating from. Less intensive fighting over the last two days has allowed some access to the area to recover the dead and people needing medical attention. The TSP has limited resources in terms of medical equipment and consumables. Distribution of goods has been frustratingly slow with 2-3 weeks between the request and delivery, this being another stressed aspect of the border blockade.
Rescue missions continue to be high risk to staff as well as nationals moving through the area. Healthcare workers and rescue teams have been targeted across the Gaza Strip.
There has been consistent shelling and aerial gunfire from the seaside over the TSP. We did witness small boats being targeted. We also observed and heard heavy artillery, mechanized ground forces, and airstrikes near the TSP throughout the day at roughly 4-7 km away. Our team always has at least one vehicle and driver on location for emergency escape as well as a HELP kit, a team bag that provides emergency support for 72 hours with food, medical supplies, water, sleeping gear, and power in case the team gets stuck out in the field.
Medical supplies are being depleted at a high rate. These include sterile and rolled gauze, IV tubing, sutures, scalpels, nitrile gloves, surgical scissors/clamps/suture trays, saline, tape & elastic wrap, hemostats/drivers, hand sanitizer, needles, oral antibiotic, oral Zofran sublingual, betadine, trauma sheers, IV tourniquets, and bulb syringes.
Day 3
UN agency food stores and shelter accommodations are being affected by the erratic opening and closing of the Rafa crossing, as well as large crowds intercepting these shipments before they can be disbursed equitably. Communicable diseases are on the rise. Cholera is very much a concern and the WHO is considering measures to quarantine aid workers from high-risk countries for at least 2 weeks in Cairo before entering Gaza.
We were notified of a strike on Doctors Without Borders guest house that killed 10 national staff workers. In addition, ground forces and tank battalions moved into the western Khan Younis area only 3-4km from the TSP.
A group of people going to the remaining mosques in the Rafa area for early morning prayers set off a flurry of IDF attacks, including an air strike on a home. An estimated 25 Palestinians were killed, and an unknown number were injured.
Combat activity continued at Nassar hospital in central Khan Younis with many individuals arriving at the TSP either DOA or having sustained traumatic injuries days prior and only now being able to reach medical assistance.
There has been an increase in combat in Deir Al Balah. Many international NGOs are making plans for relocation to the middle in the event of a ground invasion in Rafa.
We are deeply concerned about our safety, especially with the strike on the Doctors Without Borders guest house. At the NGO meeting today, details came out saying that it went on for at least 3 hours and claimed the lives of 10 national staff workers for Doctors Without Borders and 28 Palestinian civilians in the area.
At the JHOC for daily cluster briefing, there was a discussion about the potential need for international NGO staff to hibernate in Rafa as fighting draws closer. We also learned that the police have left their posts, effectively closing the crossing temporarily until an agreement can be secured to continue a stable environment for aid trucks to pass into Rafa without being overrun immediately.
OCHA/WHO/UNRWA is sending another reconnaissance team with medical supplies, food, and water to Al Nassar Hospital. They will extract stable patients. Reports of the grim, dire situation there are being pressed at the highest levels of WHO to get access to the hospital, but there are many challenges and obstacles to the process that keep delaying this.
The team saw a rise in gunshot wounds and blast injuries coming from the middle area of Khan Younis and Bani Suhelia areas. These wounds include compound fractures, multiple entry-exit wounds, embedded metal shrapnel from quadcopter and drone strikes, blunt traumas from drone/tank strikes where individuals are hit by debris or collapsing buildings.
Victims recovered after multiple days arrived throughout the day, and we’ve seen an increase in the number of children and young women coming in with lacerations, fractures, shrapnel, and blunt traumas.
We’ve heard reports of a potential ceasefire before Ramadan. In the meantime, the last f3ew nights there have been an increase in explosions as tunnels are reported to have been located in the Khan Younis area.
We are monitoring the proximity of fighting both relative to the TSP and guest houses where we and other teams are staying. On multiple occasions, our team has witnessed gatherings of people becoming violent for unknown reasons. As a result, multiple patients arrive at the TSP with blunt traumas to the face, skull, arms, and legs after being hit with batons or metal pipes.
Traveling on the beach road has become more challenging with the number of people now residing on either side of the beach. Our drivers do an exceptional job of navigating the crowds and some side streets to get to and from the guest house each day.
Day 4
The stabilization center for malnourished children is almost complete after an expedient 10-day construction. Meanwhile the Primary Health Clinic has been operating 24/7 since the onset of the unprecedented attacks on Gaza, the clinic is supported by Med Global and Human Concern International. Med Global also runs multiple medical access points that have a pharmacy, general practitioners, Butterfly ultrasound, and some obstetrics.
Reports from various sources within the WHO and UN agencies have made it clear that the status of the ceasefire is still very much unknown, and we should be planning on movements without proper precautions and notification until there is a confirmed cease-fire or temporary pause in hostilities.
We’ve heard reports of large groups moving throughout Khan Younis taking it upon themselves to hand down “justice” to those caught looting or stealing from various distribution centers. The ability of the police at this point to manage these groups is still unknown, but at the TSP, we are treating stab and slice wounds, blunt traumas, compound fractures, and gunshot wounds from these encounters. Developing daily, some of these groups have come to the TSP looking to further impose “justice” on these injured individuals and have had some heated exchanges with the PRCS staff, but they have continued to manage and deescalate these encounters.
Day 5
At the JHOC the international NGOs discussed the evolving situation surrounding patient evacuation convoys to Al-Nassar and Al-Amal Hospitals in coordination with WHO/OCHA. These convoys are facing many challenges navigating to the hospitals which could cause the patients to deteriorate.
Our team continues to work beside the local staff at the TSP. There has been an increase in patients with gunshot wounds, blast injuries, and shrapnel injuries that have just occurred within closer proximity to the TSP than in previous days. Ground forces are moving faster than previously projected by UNDSS (United Nations Department of Safety and Security).
The field hospital is still not open due to medical machines and resources being held at the crossing. We don’t know when/if the site will be viable; right now, we have limited capacity with low resources, supplies, and beds.
Day 6
At the JHOC daily meetings, some agencies are speaking about plans to maximize a potential pause in hostilities or ceasefire, primarily how to access the middle area and northern Gaza. The notion of how to even begin to assess and start to aid in the north is a severely daunting task that many agencies are prepping for.
We have received advisories on potential altercations and violent encounters around Tal Al Sultan and other identified roads near the Rafa crossing. Aid distribution convoys continue to be targeted by crowds and intercepted as the chaos, tension, and desperation of Gazans increase daily.
More MCIs (mass casualty incidents) per day means less downtime with the frequency of patients coming in, many young men with gunshot wounds and blast injuries. There has also been an increase in the frequency of DOAs, some 1-2 hours old and others 5+ days-weeks old being recovered and brought in.
The Jordanian Air Force made several aid airdrops across the southern, middle area, and northern Gaza Strip. These parachuted parcels drew massive cheers as our team witnessed masses of individuals rushing by any travel means in the direction that the wind carried the drops. Several parcels landed a few hundred meters off the beach in the ocean, forcing people to swim out to recover them.
Unfortunately, the relief also sparked unrest and violent exchanges as people are desperate for food. Many people soaking wet and exhausted were brought with stab wounds, blunt traumas from sticks and metal pipes, fractured arms and legs, heinous beatings, and even some caliber gunshot wounds have come in after these aid drops.
Today at the primary healthcare center there was an altercation between two families just outside of the main entrance. A weapon was involved, and the situation escalated to the point that 7 people were killed and we don’t know how many others sustained injuries. Our staff is on heightened alert to monitor situations that could quickly deteriorate.
Day 7 in Gaza
Extensive ground operations took place overnight, with no reprieve from the constant bombardment. We could hear naval and aerial attacks throughout the night as well as sustained gunfire followed by tank rounds.
There was another round of Jordanian Air Force aid drops across the south and middle areas of the Gaza Strip. Again, this triggered massive crowds and fights over the limited aid. The Rafa area is now estimated to hold 1.5 million Palestinians. More injuries and brutal beatings showing up at the stabilization point directly following the airdrops.
Day 8 in Gaza
We are seeing targeting of both IDP (internally displaced person) tent areas and private homes, as well as areas of Rafa where a high concentration of Palestinians had been gathering either for aid distribution or moving about the area for daily needs. Several areas across the southern border have also been targeted by naval and aerial bombardments during the night.
There was a missile strike on a café 500 meters from the guest house, causing an unknown number of Palestinian deaths. There is much discussion among the local population about what the next phase of this attack will bring.
There have been no developments with medical evacuations and no developments on the Palestinian Red Crescent Society’s field hospital being able to open for type-4 capacity.
After the long night, our team treated several children with blast injuries today and received a number of children DOA, all under 8 years old.
Naval shelling and very close artillery fire shook the TSP for a substantial period during the afternoon. We continue to assess our risk tolerance relative to the number of patients being brought to the TSP. The risk of ground troops is high but for now, we are working very well with the national team and will continue to maximize our presence and assistance to their staff.
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