'It was heartbreaking': Canadian trauma surgeon describes scenes in Gaza hospital

“It's just one of the most difficult decisions you make in your life as a doctor,” he said, noting many of those patients were young children facing life-altering injuries. “I've seen a lot of children dying before my eyes every day.”

Al-Kassem, chief surgeon at Norfolk General Hospital and West Haldimand General Hospital south of Hamilton, was one of half a dozen Canadian and American doctors who entered Gaza on Christmas Eve to assist with the overwhelming humanitarian crisis, part of a program coordinated by the World Health Organization and Rahma Worldwide, a U.S.-based humanitarian relief organization.

On Friday, a day after Al-Kassem returned to Canada following his 12-day trip, he spoke with the Star to share his experience working in the war-torn territory, and the stories of the patients he lost and helped save.

In the three months since the onset of the Israel-Hamas war, Israel’s land, air and sea assault in Gaza has killed more than 22,400 people, more than two-thirds of them women and children, according to the Health Ministry in the Hamas-controlled territory. In November, several UN experts said Palestinians were facing “apocalyptic” conditions and warned of “a genocide in the making.”

Israel’s campaign, which has faced heavy international scrutiny over the mounting civilian death toll, came in response to Hamas's surprise attack in southern Israel, which killed roughly 1,200 people, mostly civilians, and led to some 240 others being taken hostage.

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Israel has said it needs to continue its military campaign to eradicate Hamas to ensure peace. Critics have accused Israel of collectively punishing the Palestinians of Gaza through the bombardment and land invasion.

Al-Kassem and his colleagues worked out of two hospitals in the southern Gazan city of Khan Younis. There, he said, they often treated victims of airstrikes suffering from trauma to their head or limbs.

He recalled one incident during his trip when an air raid struck a building several hundred metres away from the hospital where his team was working.

“All of a sudden we received 15 children, women and men,” he recalled. “Unfortunately, even if they still have a pulse, you cannot treat everyone. … It’s heartbreaking.”

But Al-Kassem was not just a witness to suffering. He eased it, too. Al-Kassem said he'll never forget the case of an eight-year-old boy who needed heart surgery after an Israeli airstrike hit his house in southern Gaza, where his family was sheltering after fleeing the north.

Alongside fellow Canadian surgeon Dr. Amgad Elsharif, now in Egypt helping send medical supplies into Gaza, Al-Kassem revived the boy and cleared shrapnel lodged in his heart. It's a procedure Al-Kassem said would have been a feat even with all the resources of a Canadian hospital.

He said his colleagues, some of whom he worked with in conflict zones past, would comfort each other through the heartache with thoughts of all those they were able to save.

"My principle is that if you save a life as if you save the whole humanity,” said Al-Kassem, paraphrasing verses that appear in both the Quran and Talmud.

The boy’s family was so appreciative, they brought Al-Kassem and Elsharif fruit juice — a scarce commodity he said he hadn't previously seen in Gaza because of the ongoing blockade and food shortages.

Al-Kassem, who has five children, said he felt fortunate to be able to offer chocolate bars packed by his wife to children he saw in the hospital. A small comfort in desperate times.

“Some of them did not eat proper food for three months or so,” he said. “They’re lacking soap, they’re lacking water, they’re lacking everything. Heartbreaking to see the children suffering.”

There is little comparison between Al-Kassem's work as a trauma surgeon in Canada and what he faced in Gaza. For months, many doctors in Gaza have not been able to leave the hospitals they work in because there is no one to replace them, he said.

When Al-Kassem worked a surgical fellowship in Calgary, there was only one gunshot victim the whole year. But while ERs in Canada do not see the same wounds as one in a war zone, he said his experience did give him the organizational skills he needed to determine which patients to prioritize.

“You need a lot of skill to know who will survive,” he said.

In Gazan hospitals now, doctors are comparatively few, antibiotics are scarce and disease is flourishing. Often, Al-Kassem said, he had to amputate a limb he knew he could have saved if he had the resources.

Even in Aleppo, where Al-Kassem travelled during the height of the Syrian civil war to volunteer, conditions were better, he said, and hope existed for people with more complex injuries.

“In Aleppo, at least we had the opportunity to transfer the patients to the border,” said Al-Kassem. “Unfortunately, this does not exist in Gaza, and therefore we see more casualties, more deaths in the Gaza war.”

Outside of his work in the hospital, Al-Kassem described the dire scenes from Khan Younis: the sounds of airstrikes at night, the holes in the ground where buildings once stood, the streets lined with plastic tents where refugees now live.

“It doesn't feel like a city anymore,” he said. “It feels like it is a big camp of thousands of refugees.”

At night, Al-Kassem was forced to rest. With Israeli bombing intensifying, he said, ambulances dared not operate as any moving vehicle could become a target at night, he was told by drivers.

As a result, hospitals were flooded with injured civilians come morning, but it was often too late to save them by then, Al-Kassem said.

Israel’s bombardment and ground invasion of Gaza, now in its 13th week, have pushed almost all Palestinians toward the southern city of Rafah along the Egyptian border. The area had a prewar population of around 280,000, a figure that has bulged to over one million in recent days, according to the UN agency for Palestinian refugees.

In addition to the threat of airstrikes, health officials have also warned of the growing spread of diseases, especially among children.

The World Health Organization has reported tens of thousands of cases of upper respiratory infections, diarrhea, lice, scabies, chickenpox, skin rashes and meningitis in UN shelters.

The rapid spread of disease is mainly due to overcrowding and poor hygiene caused by a lack of toilets and water for washing.

Al-Kassem said of all the Palestinians he met in Gaza, none were untouched by Israel’s attacks. Every one of them had family members killed.

Western nations, including Canada, have affirmed Israel’s right to defend itself after the Hamas attack. As the death toll in Gaza has soared, however, there have been increasing calls for restraint, including from Canada, which last month voted for a non-binding UN resolution in favour of a ceasefire.

Ultimately, after his two weeks in Gaza, Al-Kassem said he believes the war must come to an end, and hopes for an immediate ceasefire.

“Whatever your political thinking or religious background, the loss of civilians and children, dying every day, is just wrong,” he said. “There should be a different way to solve problems than the bombardment of civilians.”