This article contains graphic photos and descriptions of injuries in Gaza, where the Israeli Defense Forces have been indiscriminately bombing since Oct. 7, 2023, killing at least 35,000 Palestinians and injuring at least 77,000 more.
When I ask Dr. Dhiaa Daoud what he saw while working in the emergency room of Gaza’s overcrowded European Hospital, he falters. “Sometimes I wonder if I should tell you what I saw or not,” he says. “But you probably should know.”
A Palestinian American emergency medicine specialist in Florida, Daoud returned this month from a two-week medical aid mission in Rafah, organized by the NGO Rahma Worldwide. It was his first time back in Gaza, where his family was displaced from decades ago, since he was a child.
“While I was screening the patients — who is alive, who is needing more help, who is dead, who is not breathing — I will feel a pulse while I’m videotaping and then I will just continue,” says Daoud. But after responding to the first two mass casualties, he stopped recording. “Unfortunately, the internet is full of these videos and I just realized that if [that] didn’t move you, I wasn’t sure if whatever footage I have would.”
Eight babies and toddlers with third degree burns, lying on the ground in need of intubation. A bag filled with limbs and intestines. I take notes diligently as he speaks, yet when I get a notification on my phone a few days later – Dhiaa Daoud has shared a photo album with you — nothing can prepare me for the images and footage I see.
The flesh peeling away from the muscle beneath, the wailing children, the blood, the pallor of the bodies littering the hospital floor, the young children loudly reciting chapters of the Quran to distract themselves from the pain of treatment, the doctors playing soccer with the local kids as drones hum in the background, the tens of thousands of refugees crowding the hospital’s corridors.
Daoud says he has trained himself to block out the worst of these scenes. “But they come and they haunt you,” he admits. Below, read our conversation, edited for length and clarity.
As a Palestinian yourself, how did it feel for you and your family watching the bombardment of Gaza over the past six months?
Heartbreaking. Our hearts ache and bleed because of what we’re seeing every day in Gaza. I was honestly going into a period of severe depression, which I’m sure that everybody who has a conscience is as we realize that what’s going on is a true massacre and true genocide.
You feel crippled when you see all of that and can’t do anything. Every single person I met during my journey was in tears when they heard that I’m going to Gaza. Everybody wants to go help — the person who carries your bag, the chef in the restaurant.
The widespread destruction of Gaza’s healthcare infrastructure has been widely reported at this point. What were you expecting the situation to look like on the ground? How did that compare to reality?
I wasn’t sure what to expect. There was a looming feeling of, Am I going to be helpful? What can I do for them? I’m just a person. That feeling disappeared the second I walked into the ER. The amount of people that needed help was gigantic, enormous. I’ve never seen something like that. I was literally in front of 300 people. They’re all talking to me at the same time, they’re all scared, they all have needs.
The first day, I had probably close to 15 people, and I was rotating from one person to another to see who’s dead, who’s dying, who’s about to die. It was just unreal. Unreal. You’re trying to just judge between whether I should help this dead person first, or dying person first, or somebody who’s about to die but I can help. It’s extremely heartbreaking, and nobody needs to go through this.
Every day, there is a genocide. Every day, there are hundreds of people being killed in Gaza. It’s happening. The pictures and the videos that you guys are seeing, it does not give justice to what the situation is.
The European hospital in Rafah is now the main hospital in the entire district of Gaza. The rest, like El-Najar or Al-Aqsa, are very small hospitals meant to serve small rural areas. Now they’re bombarded with a massive influx of refugees that were displaced to these areas and serving millions of people. But their capacity is very limited and they’re only doing simple things, stabilizations — if a person cannot breathe, they put a chest tube in them and transfer them to the European Hospital. They don’t even have a CT scan.
There are different kinds [of patients] in the ER. Number one, the people who are injured. The people who need fixation for their [fractured] legs, they usually place an external fixator — basically some metal that is embedded in the bone — and it’s meant to be taken away after a few weeks. But over there, they’ve been staying in for six months, and nobody can take them out. The facilities are unable to handle this amount of injured people. Everybody is on a list that is four months long.
We also tried to accommodate the needs of people coming for treatment of their chronic illnesses that were forgotten because of the lack of healthcare system. Then there’s additional emergency situations, appendicitis and things like that. And add on top of that, the influx of injuries that comes from explosives. They come in tens of people at a time, and they’re all children. They’re all women. They’re all kids, babies. I just don’t understand how we can stay silent for that.
It’s simple. I’m telling you right now, I watched every single one of them in front of me in Gaza. It was every day. Every day, there is a genocide. Every day, there are hundreds of people being killed in Gaza. It’s happening. The pictures and the videos that you guys are seeing, it does not give justice to what the situation is.
Why did you decide to take photos and videos to share with the public?
As an emergency physician, your job is to focus on helping these patients, but you’re torn because you really want everyone to see what is going on over there. Part of the solution to this problem is awareness about what’s happening.
While I was screening the patients — who is alive, who is needing more help, who is dead, who is not breathing — I will feel a pulse while I’m videotaping and then I will just continue. I did that a few times, and then I just stopped. It gets into you, and then you just try to focus on the medical part. That’s what happened with me after the first two or three mass casualties, I just couldn’t videotape anymore. Because unfortunately, the internet is full of these videos and I just realized that if [that] didn’t move you, I wasn’t sure if whatever footage I have would.
These people are just literally taking missiles with their bare chest, experiencing the collapse of all of their surroundings on them, and sometimes the nightmare of being collapsed under a wall for a very long time until somebody can get into you — or sometimes not. That’s the sad reality of every mass casualty over there.
Like one kid — unfortunately, he passed away. I was looking for a pulse, and there’s no pulse. I came back to listen to his heart because I felt so bad. He was gurgling, so I was hoping that maybe I can save him somehow. I started doing CPR on him and they started begging me not to do it. I felt horrible, heartbroken. They’re begging me not to do resuscitation because we don’t have facilities for these kids. We don’t have anything, we don’t have ventilators to help these kids, we didn’t have a place for them in ICU. They might stay there for a few days, and then after that, they’ll die. Unfortunately their fate is destined to a very bad ending, but inshaAllah [God willing] they’re in jannah [heaven].
These kids, they’re the ones who actually liberated us. The real heroes are these babies that are taking F-16 missiles with their bare chest. These are the real true heroes that the world needs to see, that the world needs to stand by. These kids with these amputations, losing their arms and feet and legs — this is not how they imagined their lives. And they never imagined that nobody would ask about them or help them or stop this massacre. We Americans are complicit to this, we pay taxes and our taxes go to Israel. What are we waiting for?
We’ve been hearing reports about the particularly high impact on women and children. Doctors who have come back from Gaza have described record numbers of pediatric amputation, the emergence of the “Wounded Child, No Surviving Family” acronym, and childbirth without pain relief and under unbelievable conditions. Can you talk more about the particular impact you saw on pregnant women and young children?
Almost all of them are women and young children. Almost all of them. Honestly, I rarely remember a guy or an adult [man], coming to the emergency department. Unfortunately, they’re all babies, children and also women. And they’re severe injuries — we’re talking about a leg hanging by skin and nothing in the middle. We’re talking about chest traumas, facial traumas. I’m sorry, I don’t want to be graphic, but it’s extremely difficult to describe.
You should know that I’ve seen very difficult scenes, like brains coming out of the skull in front of you. Or one time I opened a bag, and it was only limbs. Limbs, intestines, things like that. There was a bag of a guy, his face was literally squared – it was unbelievable. The scenes there are just very difficult to watch. All I can say is these mothers are in heaven, inshaAllah [God willing], for what they witnessed. And they did nothing wrong in their lives. They have nothing to do with anything. They’re all babies – you cannot tell me it’s political. There’s nothing political about babies. They’re just there.
One of the kids told me, “We were just eating futoor (breakfast) after a long day of Ramadan fasting. We were about to drink karkade and then a missile hit, and then the whole entire ground is falling, and the roof is falling on us.” He remembers everything. It’s crazy. It’s unbelievable. How can a child witness that? You’re in your house, and you are hit by a missile, okay – it’s not a bullet, it’s a missile, inside your house — and the entire building is falling on top of you. This is his exact description. Nobody has to go through this.
The ER is not an easy place, whether in Gaza or Florida, but what was it like to see that disparity between the two settings?
Going to missions like these makes you more human. I believe that every single one of us has to experience or witness things like that so that they can be better, to put it simply.
There’s so much that needs to be done, and I felt guilty leaving there without having an impact. We tried to do a lot of things. I was busy in the ER and helping as much as I can, to the point where we were just drowning, literally sleeping a few hours and then going back in every single day because we wanted to help as much as we can. When we were in our room in the building next to the hospital, whenever we felt the building shaking from a [nearby] bombing, we immediately would go down. We were always on high alert when we heard a massacre, even if we were sleeping.
They’re begging me not to do resuscitation because we don’t have facilities for these kids … They might stay there for a few days, and then after that, they’ll die.
The amount of work and the amount of catastrophe is huge. There’s about 35,000 refugees living inside the European Hospital. The hospital was inundated with these people who are scared and came in seeking refuge — they’re living everywhere, in the corridors, on the stairs for six months. It makes everyone in the healthcare sector’s job difficult and adds to the problem. We have the epidemics over there, the scabies, the head lice, the chicken pox, the hepatitis A all rampant over there. Almost everyone has hepatitis A, and there’s no way to test them; they just come in to you and it’s all physical exam findings. You just see them yellow, they tell you the symptoms of vomiting and abdominal pain, and then you know that it could be something else but most probably it is hepatitis A.
People didn’t do anything, but now they don’t have money, don’t have jobs and have been refugees for six months in tents surrounding the hospital and everywhere in the entire region. Add to that a looming fear that the U.S. and Israelis are going to come and invade Rafah — if that happens, it’s going to be a catastrophe. Because they witnessed what happened to them in northern Gaza, and in Gaza itself, and now they know what to expect.
For months, experts have been warning that famine is looming in Gaza, and some parts of the Strip are already facing it. Access to clean water and the spread of infectious disease are reaching crisis levels. Did you see that scarcity of food and water reflected in the condition of the people who came into the ER for treatment?
There’s two parts to the problem. The first part is that the injured people are not not being taken care of because of the huge influx of injured people, who are being treated only in one hospital. There’s a very high demand and there’s almost no supply.
The other issue is there are complications because of that. There are infections because these people are not living in a good sanitary condition. They’re living in a horrible environment, like a tent next to a sewer. It’s adding to the problem of these epidemics you’re seeing over the entire region. You have scabies, you have chicken pox, hepatitis — it’s going to overwhelm the entire system that has already already collapsed honestly.
How can you offer any basic needs, even healthcare, when these people don’t have food? How can you treat a patient when they don’t have food? How can patients recover? The patients who are coming with injuries and burns from missile attacks, they need sanitary conditions, and the hospital is not a good place right now for that at all. The hospital right now is filled with epidemics – these diseases, they’re just rampant. How can you put a burn patient there?
How can you offer any basic needs, even healthcare, when these people don’t have food? How can you treat a patient when they don’t have food? How can patients recover?
One time we had eight burned babies. Eight. And they were all on the floor. I’m lucky to have a good stomach to see things in the ER, but this was the first time in my life that I froze. It was a scene that I never expected to see. I remember seeing these things like I’m in a movie, or rather a nightmare. And I’m just looking around me, surrounded by these babies with third-degree burns. They can’t breathe and we’re supposed to intubate every single one of them, to allow them to breathe. I remember another ER physician talking to me and I wasn’t responding. He shook me and he’s like, “Are you okay?” That was the kind of shock I had when I saw all of that. And I said yes, and I continued to work. They were all intubated and they went to the ICU. One of the doctors over there called for international assistance to take these babies somewhere, because these babies need good, sanitary conditions to survive. Unfortunately, they all died.
We were intubating on the floor, doing resuscitation on the floor, even chest tubes and central lines on the floor. They need to be done in extremely sterile conditions, but it’s a very dirty environment around you. As a physician, if you’re placing a certain patient with an external fixator and sending him outside in an unsanitary environment, then you’re just basically waiting for an infection to go into that limb. So we established certain programs to cleanse the hospital and combat the illnesses, even working with the refugees, and that was a big success.
Rahma Worldwide and other NGOs are looking for more accredited medical professionals to travel to Gaza to provide aid. What is your advice to those who are considering it?
I want everybody to go and share that experience with everyone around you. Tell them what you saw, tell them how the people are suffering over there so people can take action.
If you have the capacity, the money, the time to actually go, please do. They need people. The staff over there is completely burned out. They’ve been working nonstop and they’re not getting paid, or they’re getting paid minimal amounts of money so their families can survive.
This is my first medical aid trip, but I’m planning on making it a mission for me from now on because I realized how much disparity is in the world. There is so much suffering and injustice. I feel like Gaza woke me up — and woke every single one of us up. It was like a shockwave that went from Gaza to across the world. It became a mirror for a person and if you are standing with justice or injustice. It’s as simple as that: You look in the mirror, and if you say, “You know what, yeah. Seeing these kids dying is what needs to be done,” then you need to take a deep look into your soul.
