Watch Part 2 of our interview with Dr. Mads Gilbert, a Norwegian physician specializing in anesthesiology and emergency medicine who has helped provide emergency trauma care in Gaza for over four decades and is now trying to enter the besieged territory from Egypt. “You need to choose” what side you are on in situations of injustice, he says. Gilbert describes medical solidarity work to support the Gazan medical staff in hospitals who are experts in mass casualties, and the impact of Israel cutting off water, medicine and communications. Gilbert is a professor at the University Hospital of North Norway and the Arctic University of Norway. He has been working with the Palestinians since 1981 and was in Gaza during past major bombardments in 2006, 2009, 2012 and 2014. He’s delivered life-saving trauma care emergency medicine, mainly in Al-Shifa Hospital, but also in al-Quds Hospital. Dr. Gilbert is currently with an emergency medical team supported by the Norwegian government in Cairo, Egypt, where they have waited for over two weeks to enter Gaza. He is the co-author of several books on Gaza, including Eyes in Gaza and Night in Gaza.
AMY GOODMAN: This is Democracy Now!, democracynow.org, The War and Peace Report. I’m Amy Goodman, as we continue now with Part 2 of our interview with Dr. Mads Gilbert. He’s a Norwegian physician specializing in anesthesiology and emergency medicine. He’s a professor at the Arctic University of Norway. Dr. Gilbert has been working with Palestinians for 30 years, has been in Gaza there during all the major bombardments, in 2006, in 2009, 2012, 2014, delivering life-saving trauma care emergency medicine, mainly at the largest Gaza hospital, Al-Shifa, but also in al-Quds Hospital, that the Israeli military is saying must be evacuated immediately. Dr. Gilbert is currently with an emergency medical team supported by the Norwegian government. He’s in Cairo, Egypt, where they have waited for over two weeks to enter Gaza. Dr. Gilbert is the author of several books on Gaza, including Eyes in Gaza and Night in Gaza.
Thank you for staying with us, Dr. Gilbert, for this continuation of our interview. I ended the last part of the interview by asking you why it’s so important for you to go to Gaza. You were just in Gaza a few months ago. Talk about what you did there then. And why now with this total siege of Gaza?
DR. MADS GILBERT: Thank you, Amy. And thank you for having me.
Why go to Gaza now? Well, it’s very simple. You need to choose in historical situations and in situations of injustice. You cannot stay indifferent. I have chosen to be on the side of the Palestinian people and their right to resist occupation, colonization and apartheid. And part of that choice of side is that I ask myself, “How can I, as a doctor, support the Palestinian people in Gaza?”
And I’ve been doing, over the last 30 years, several things. We have traveled — every time there has been bombardment, we have been traveling to support the medical staff or colleagues in the emergency hospitals. And mind you, not before they — not because they cannot do the job themselves, because they are, unfortunately, world experts in mass casualties and these immense patient loads on the hospitals, no, but because in situations where you are really up against the wall, there is a word that is called solidarity, which is important, that somebody sides up with you, supports you, see you and come to your assistance. So I call this medical solidarity work. And the most important part of that is, of course, to take the stand and be on the side of the oppressed. That may be maybe very big words, but those are the choices.
I’d like to underline that, with relation to each individual patient I treat, of course, I’m completely neutral. If it was an Israeli soldier, a Palestinian child, a pregnant woman, whoever, I would do my doctor’s job according to the ethical principles. But I choose to go to Gaza and not to Israel, because I choose their side.
What have we been doing? We’ve been doing this emergency work. I teach at the Al-Azhar University, which is the second-largest university in Gaza. They have two large universities. It’s the Al-Azhar and the Islamic University. By the way, the new building of Al-Azhar University was bombed last night. So, I teach medical students. I’ve done that for many years. Together with the students, we’re running laypeople training projects. We’re training laypeople in Gaza life-saving first aid, how to open the airway, stop the bleeding, find a good position, keep the victim warm — much needed, as you can see now. We have done extensive research, medical research, published in peer-reviewed journals like The Lancet, British Medical Journal. And I have always followed up the patients that I have participated in the treatment of, like the children that I was team working on, with, in 2009. So, now I have a whole family, a whole set of families, with kids who have now grown up and became mothers and fathers themselves. And their history and their development and their conditions in Gaza has been my most important source of information as to what it means to be a Palestinian family in Gaza. So, many different activities, going back two, three times a year, also working for the very good American NGO, Palestine Children Relief Fund, PCRF, who does tremendously good work in Gaza. So, it’s been a very varied menu of activities, but always civilian.
AMY GOODMAN: So, Dr. Gilbert, you say you have the full support of the Norwegian government. You have a team there trying to get into Gaza. Who’s stopping you? You’re right now in Cairo.
DR. MADS GILBERT: We have the support, financial support and the practical support, of the Norwegian minister of foreign affairs and the government, that’s right. It’s complicated. It’s almost impossible to get to Rafah, because you have to trespass a number — you have to pass, sorry, a number of obstacles. You have to have permission from the Egyptian minister of internal affairs, the minister of foreign affairs, and you have to have permission from the Egyptian military security. We have the two first; the third, we have not got. So, you cannot get to Rafah, because it’s a car travel six, seven hours from Cairo, through the Sinai Desert, then up to Rafah, where the border station is there. It’s not a border, because there are no international borders around neither Gaza nor occupied Palestine. But you get to Rafah, and then you have to have your paperwork done. But also, to go through Sinai, you cannot do that. You can’t just hire a taxi in Cairo and say, “I’m going to Rafah.” You will have to pass a number of checkpoints, military checkpoints. So we have not been allowed.
AMY GOODMAN: So, the Israeli President Isaac Herzog claimed no one is innocent in the Gaza Strip, including civilians. This is what he said.
PRESIDENT ISAAC HERZOG: We are working, operating militarily, according to rules of international law, period, unequivocally. It’s an entire nation out there that is responsible. It’s not true, this rhetoric about civilians were not aware, not involved. It’s absolutely not true. They could have risen up. They could have fought against that evil regime which took over Gaza in a coup d’état. But we are at war. We are at war. We are at war with the other. We are defending our homes. We are protecting our homes. That’s the truth. And then, when a nation protects its home, it fights. And we will fight until we break their backbone.
AMY GOODMAN: “We will fight until we break their backbone,” President Herzog said. Dr. Gilbert, the weekend has just passed. Israel cut off all electricity and cell service. What does this mean for hospitals? A U.S. military analyst said Israel’s engaging in info ops, information operations, and that they wouldn’t want to the outer public to see dead children or to hear an interview with a medical doctor talking about the plight of the hospitals right now. If you can talk about what that complete shutoff, though they’re gradually putting it back on, means for hospitals?
DR. MADS GILBERT: I’d just like to make one comment to the Israeli president. They are not at war with the civilian people of Gaza. They are at war with international conventions and the Geneva Convention, because you’re not allowed to bomb and kill a civilian population which is unarmed. It’s simply forbidden. And thank you, because we try to make a decent world. So, that’s my comment to that.
To the siege of Gaza, it has been on for 16 years. It started in 2007. And it’s been a crippling siege. We have studied it. We have reported on it. The U.N. has reported on it. It’s made Gaza into a ghetto. I never use the “prison” term on Gaza, because in prison there are people who actually have done something wrong, criminal, and they are sentenced to be in prison. Palestinian people in Gaza, the civilians, the kids, the mothers, haven’t done anything else than by being born Palestinians in Gaza. So, this siege for 16, 17 years has already forced the Palestinian society, the healthcare, the education, the businesses, the whatever, down on its deep knees.
Then, when this started — and it didn’t start with the shutoff of the mobile network — it started immediately, when, on the Sunday, after this — Saturday, when the Israelis said, “We will completely shut off Gaza.” They turned off the light. They turned off the water. They turned off any entrance. And by that, they actually rendered 2.2 million people completely without the necessities of life. So, this siege, this increased siege, has been going on for three weeks. And the results — just let me tell you what my colleagues told me yesterday in Shifa Hospital. They don’t have water to drink. They have maybe 300 cc of water to drink. They have to wash in saline dirty water, because all the desalination plants in Gaza are shut down. They have a massive problem with wound infections, because they cannot clean their instruments and have cleanliness around the patients. In Shifa now they have 100 burn patients with more than 40% burned body surface area, most of them children. Infections in these burns are fatal. You get septicemia. So just to cut off the water to 2.2 million people, who cannot produce the water themselves, is a war crime.
Secondly, this shutoff of electricity, without allowing the fuel to come in to run the generators in the hospitals and everything else in Gaza, makes the hospital completely inoperable. And so far 12 hospitals and 32 primary healthcare clinics have been shut down, partially because of lack of electricity and partially because of damage from bombardment. So, this blockage of electricity, water, food and medical supplies is actually enabling — it’s crippling the whole civilian fabric. It’s an avalanche of human suffering. It’s an avalanche of human suffering in Gaza now, in addition to the death and the wounding of the civilians, because people are fleeing, they are scared, they don’t have anywhere to stay, so they seek refuge in the hospitals and in the UNRWA schools, which are also being bombed. They are in very much need of being in touch with each other and with their relatives abroad, because, in crisis, what you need the most of all is your family.
And for the hospitals, it’s on the brink of total collapse now. I saw a movie yesterday filmed inside Shifa Hospital, where there is currently 50,000 refugees. And it’s so packed, you can’t even pass a bed, because all these civilians fear bombing, and they fear getting killed, so they seek to where there is some sort of structure left. And these two big hospitals in northern Gaza, Shifa and Mustashfá al-Quds, they are cornerstones now of whatever is left of social fabric and safety in Gaza, in northern Gaza. So, when the Israeli occupation forces are threatening to bomb them, as well, I don’t know what the next will be.
AMY GOODMAN: And this debate over whether you can trust the Gaza Health Ministry’s figures on number of deaths, now over 8,000, more than 3,000 children killed, President Biden repeated that. Yet you had human rights groups, like Human Rights Watch and others, saying the State Department has relied on these figures and have said that they’re legitimate. The human rights groups have, and the United Nations has. Your response? They’re saying because the Health Ministry is run by Hamas — it’s the government of Gaza — you can’t trust those numbers.
DR. MADS GILBERT: Who can you trust in this world, Amy? I wonder what’s wrong with Joe Biden? Where did he get documentation to say that you can’t trust these numbers? I think the Palestinian people currently in this world is the only people who have to prove that they have been killed.
Look, we have been doing research in Gaza for more than 20 years. We have published numbers in scientific peer-reviewed journals, The Lancet, British Medical Journal, based on these numbers. Because we are scientists, we are obliged to tell the truth. Now, what did we do when we were collecting these numbers? Well, we went through the Palestinian mechanism on how they gathered their numbers of injured and killed. We were in the office where this is done 24 hours per day. We saw how they did it, how they called their information officers in the other hospitals, not aligned to any political party, but, you know, clerks in hospital. We saw how they documented name, date of birth, father’s name, state of death. If they were insecure, it was marked. These lists are comprehensive, they are checked, they are cross-checked, and they’re published. And it’s the base for all the U.N. publishing, the U.N. OCHA, WHO, and also your State Department.
So, where is — you know, this is part of the fog of war, of the disinformation campaign: Everything the Palestinians are saying is a lie; everything the Israelis and the Americans are saying, it’s the truth. Believe me, it’s the other way around. There are so many lies. There are so many intimidating lies, which is crossing a border on what you can do, even when you’re trying to, you know, obscure or confuse your enemy. Couldn’t we just agree on a basic thing: the respect for human life, a child, a woman, an elder, not carrying weapons, that they deserve to be protected, regardless if they are Russian, Ukrainian, U.S. citizens, Nicaraguan, Palestinian or Israeli?
What is waged now is a war against our human basis, our most humanistic principles, that each and every life is sacred. Armies may fight, soldiers may fight man to man, kill each other, like in Ukraine. We may have different positions on that. But for heaven’s sake, these numbers are right. They are the graphic illustration of the consequences and the fallout of the Israeli military complete bombardment of Gaza. And more than that, they reflect also this avalanche of human suffering that comes from the lack of water, food and shelter and security.
So, we are going to see in the coming days hundreds of wounded who will die unnecessarily, because they could have survived in a healthcare that was allowed to function at a certain level, even during this bombing. And, you know, everybody’s talking about the conflict. I’m a doctor. I’ve been trained not to treat symptoms, but to treat the root cause, of pain, of bleeding, of a lump here or there, not only to look for the symptoms. This is not a difficult conflict. This is a difficult occupation. And you have to solve the illegal occupation of Palestine and the settler colonial expansion into the occupied land of Palestine, before we can see any end to this misery.
AMY GOODMAN: And, Dr. —
DR. MADS GILBERT: And what I’m hearing — what I’m hearing from Gaza now — my last word, my last word — what I’m hearing from my colleagues around the clock in Gaza, and from my families and friends, the situation in Gaza now is so bad that Gaza 2023, it’s going to make Dante’s Inferno look like a tea party.
AMY GOODMAN: Dr. Gilbert, you spoke about the water and the problem of having clean water. Can you talk about the threat of the outbreak of diseases because people do not have clean water?
DR. MADS GILBERT: Yeah. Thank you for that question. I got a report yesterday from a colleague in Shifa who said that almost all the staff have fever now. The medical staff have fever. It could be because they’re completely exhausted, but most likely, rationally speaking, it is because they have been infected. When you have 10,000 or 20,000 or 30,000 people crammed in a very dense space, and you don’t have enough toilets, and you don’t have enough water, running water, to wash your hands, and you can’t clean your babies, and you can’t clean the wounds, you will have spread of agents that will cause different types of symptoms. You will have — from your stomach and your intestinal system, you will have diarrhea and vomit, caused by anything from Shigella to Salmonella to the other agents that cause GI infections. That’s one big problem. And already we see that.
You will have skin infections, which, if you’re an adult and you are, you know, healthy and well fed, you can handle it. If you’re wounded and you get a wound infection, it will quickly turn into septicemia, and you risk dying. So, you will have gastrointestinal infections, which spread like fire, so they will all have diarrhea. And diarrhea and dehydration will make the small ones and the sick and fragile ones quickly die, if they cannot be rehydrated with IV fluids, which they don’t have enough. Also, we fear the spread of hepatitis through contaminated water. And as we know, as I told you, they are drinking contaminated water now because there is not enough water supply. So, all of these contagious diseases, we have to expect, will spread.
And I’d like to make another note, because we always talk about the wounded and those who need wound treatment and surgery. But a population of 2.2 million people, they have common diseases. They get myocardial infarction. They get a brain stroke. They break their legs. They are going to deliver. They need cesarean sections. They will have pneumonia. All of these patients will also need medical treatment to avoid an unnecessary death. And there is no capacity for that now, let alone all the people with some sort of mental disease, psychiatric diagnoses, who are, of course, gravely aggravated in this situation of war. Where is the room to take care of all these common patients with chronic, and the diabetic patients who cannot get their insulin, and the renal failure? We know that they have 50 hemodialysis machines in Shifa. Without electricity, all of them will die.
AMY GOODMAN: And can you talk about why having water is not enough, that water needs electricity to keep it clean?
DR. MADS GILBERT: Well, if you’re going to have — I’m drinking water here in Egypt. I wouldn’t have drunk the water from the Nile. This water has been cleaned in a water — in a drinking water plant in Egypt. They are easy to set up. It’s an easy mechanism. But then you need water, which they have very little of, natural water and wells in Gaza. And you need electricity for the purification process. Then you can have bottles with water, which you can drink safely.
If you only have brackish water, which is the main component of the spontaneous or the natural water in Gaza, if you drink brackish water, you have two problems. Number one, it’s polluted. And number two, it has a too high content of saline. So you get sick from it. And 95% of the water in Gaza has been examined and doomed, or given the quality that it is unfit for human consumption. So the water situation in Gaza has always been extremely precarious and difficult. Now, when the water producing plants in Gaza are shut down, there is no natural source. You can’t turn to the mountains and find a nice little waterfall with clean water. There is no clean water naturally in Gaza. Also, because the sewage system has been broken by bombing, so the sewage will filter into the groundwater, which already is very brackish. So this is why water is so important in Gaza.
And look, 2.2 million people, they actually produce a lot of garbage. It’s around 32 degrees here now. And in Gaza, this garbage is piling up in the streets. Nobody can get it and get rid of it. In addition to that, the number of missing people in the ruins of the bombed houses is more than 2,000, among them 1,020 children. These corpses will start to rot. And those who have been in this situation, they know that the smell and just the feeling of rotten corpses is unbearable.
So, water is incredibly important. You cannot run a hospital without access to clean water, number one, to drink, to be in a stable fluid balance; number two, to clean the hospital, the floors, the walls, the operating room; number three, to be able to boil and clean instruments; and, number three, to be able to clean wounds and to just have your daily hygiene as a human being. With all these tens of thousands of families, they need to wash their kids. We need water to flush the toilets. In some of the shelters in southern Gaza, the UNRWA schools, there was — what was it? Two toilets for 14,000 people? Of course, this is going to be a major public health disaster, in addition to the trauma disaster, in addition to the disaster for human values and for international order.
AMY GOODMAN: And, Dr. Gilbert, you’ve talked about the two types of injuries: direct ones and then crush injuries, when people are in the rubble from the collapse of a building. Can you talk about how you deal with both, and, in this time when the hospitals are under so much siege, how they deal with this?
DR. MADS GILBERT: You could sort of divide war wounds into three main categories: the crush wounds from collapsed buildings, pretty much like the wounds and injuries you have during an earthquake and people cannot escape the concrete buildings; then you have the wounds from direct hits from either bullets or shrapnels; and then you have the burns.
The burns always constitute a large group of patients in all kind of warfare. And as I said, in Shifa now there are more than a hundred burns with more than 40% of burn surface. We need to get an airlift from Egypt out to the world’s burn units to save these burned children. So, the burns, extremely demanding. They need right temperature, right humidity, very much cleanliness, and they need daily debridement and shifting and then transplant, in order to save the life of the burn patient.
The shrapnels and the the bullets, they will penetrate your body, in particular, the three cavities: the skull cavity, the chest cavity and the abdominal cavity. When a bullet runs through your body, it will deliver energy, and it will explode or open up organs and blood vessels. That will cause bleedings. Bleedings internal will kill you, if it’s not stopped. In the chest, you can easily stop the bleeding by putting in chest tubes, plastic tubes between the ribs, and drain out the blood. Pretty much all the bleedings can be controlled, easily done. You can do it in local anesthetics. For the abdominal cavity, you have to open up, and you have to go in, find the bleeding, stop the bleeding by direct pressure, and then just close up, pack it, close it up, and reoperate in a day or two when the patient is stable to find the anatomical openings and suture that. For the shrapnel injuries, they can be very many. They can be like hundreds hitting a body, and you need to explore every inlet to find the trajectory of that shrapnel and to find if there is any bleeding. These are complicated, time-consuming, and you have to do what we call damage control surgery, which means only to find the bleeding, identify the bleeding, stop the bleeding, and then do the anatomical reconstruction a day or two later.
For the crush injuries, which comes from, you know, falling-down brick, concrete, whatever, you know, wood there might be, it will cause fractures and crush injuries, first and foremost, also many head injuries. They will have the problem with many types of fractures that need stabilization. There is not enough external stabilizers in Gaza now. You know, you can — if you have an open fracture, you can drill in metal bars at certain points, and you can connect the metal bars, stabilize the fracture, and they can grow together. It’s a simple, very, very elegant technical procedure, but they don’t have the bars and the Meccano you need to do the external fixation. So, in addition to the fractures, you will have the crush injuries, that you have been having a large load on your muscles, and the muscles are crushed. The problem with the crush injuries in these circumstances is that you will have complications. When all these tissue factors are released into the blood, you will clog your kidneys. So, early, early stabilization and early flushing of the kidneys is very important with crush injuries. Fractures, crush, and then, of course, the head injuries, which may be closed or open and will need intensive care.
Most of the complicated injuries in all these three groups — the blunt crush injuries, the shrapnel and the bullet injuries and the burns — will need intensive care treatment following surgery in order to survive. And currently there are 170 patients on ventilators in Shifa alone. If they lose electricity, they will lose their lives.
AMY GOODMAN: Well, Dr. Mads Gilbert, I want to thank you for taking this time. Good luck getting into Gaza. Dr. Gilbert, a Norwegian physician who’s been working with the Palestinians since 1981, has now waited over two weeks to enter Gaza. He is a professor at Arctic University of Norway. To see Part 1 of our discussion —
DR. MADS GILBERT: May I have one last word?
AMY GOODMAN: Yes, go ahead.
DR. MADS GILBERT: As a medical doctor, I think it’s important to underline now that the most important thing is not now to get a lot of doctors and fluids and drugs into Gaza. The most important medical provision now are three: number one, stop the bombing; number two, lift the siege; number three, get relief into the people of Gaza so that they can drink, eat, take care of their families. And then we have to support the medical system. Thank you.
AMY GOODMAN: Dr. Mads Gilbert, thanks so much for being with us. This is Democracy Now!, democracynow.org, The War and Peace Report. I’m Amy Goodman.