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Doctor Just Back from Gaza: Cutting UNRWA Funds Is “Unconscionable” as Hospitals Barely Functional

Web ExclusiveJanuary 29, 2024
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Image Credit: Dr. Thaer Ahmad

In Part 2 of our interview with Dr. Thaer Ahmad, an emergency room physician who spent three weeks volunteering at Nasser Hospital in Khan Younis, he describes how he saw UNRWA providing key aid to Palestinians displaced by Israeli attacks, including a shelter “packed with families and children” dependent on UNRWA to provide their daily meals. He says it is “unconscionable” to cut off their lifeline as hospitals are no longer able to provide basic medicine and care, and many people have died because they are “overwhelmed.” He also discusses the impact of the war on medical staff, who are working without pay, some of whom have been killed, including Dr. Hammam Alloh, who was killed when an Israeli artillery shell struck his wife’s home, killing him, his father, brother-in-law and father-in-law.

This is a rush transcript. Copy may not be in its final form.

AMY GOODMAN: This is Democracy Now!, democracynow.org, The War and Peace Report. I’m Amy Goodman.

We’re joined now for Part 2 of our conversation with Dr. Thaer Ahmad, an emergency room physician who spent three weeks in Gaza volunteering at Al-Nasser Hospital in Khan Younis. He’s a board member for MedGlobal, which has an office in Gaza and is working with the World Health Organization. He just returned to Chicago on Thursday, where he’s the global health director of his hospital and also an assistant professor of emergency medicine at the University of Illinois, Chicago.

We want to thank you so much for being with us. You know, I want to ask, Dr. Ahmad — we are hearing such horror stories out of Gaza. How did you have the courage to go?

DR. THAER AHMAD: You know, I think, for me, it was very personal. I’m a part of the Palestinian diaspora. I actually grew up in Chicago in an area called Little Palestine, or Bridgeview, Illinois. And so, for us, when this war started, it was really, really tough to be able to sit at home and see the images coming out of Gaza. And I know that myself and many other Palestinian Americans wanted to do whatever we could. When the opportunity came about that MedGlobal, the organization that I work with, was going to be able to provide direct medical care to the people of Gaza, I could not turn away that opportunity. And I know many of my colleagues over there definitely thought that it would be important for someone to go out there and see what’s happening on the ground and to be able to come back and share that experience.

AMY GOODMAN: Well, I wanted to get your response to this whole crisis around UNRWA right now, the decision by the United States and 12 other countries to suspend funding for UNRWA — that’s the U.N. agency for Palestinian refugees — after Israel accused 12 employees of the agency of taking part in the Hamas attack on October 7th — UNRWA one of the largest employers in Gaza with a staff of over 13,000, providing essential aid to most of Gaza’s 2.3 million residents, the agency responding to Israel’s allegations by firing nine employees. Two of the employees are believed to be dead right now. Can you talk about what UNRWA does in Gaza and what it means to be defunded? The United States is the largest funder of UNRWA.

DR. THAER AHMAD: Yeah, yeah. I mean, this is a death sentence for Palestinians in Gaza. All 2 million are dependent on what UNRWA does. And UNRWA is a lifeline to the Palestinians in Gaza, everything from shelter, schooling, water, health access points, food distribution. And UNRWA also played a pivotal role during this war. They were one of the few agencies that are on the ground, that were able to give organizations like MedGlobal and other NGOs that want to be able to help — they were able to give facts that were on the ground. And when we arrived in Gaza, we found that most of the assessments were very accurate and helpful in figuring out how to deliver aid to the people of Gaza.

Prior to any sort of war, UNRWA did this tremendous job of delivering aid to half of the population that was dependent on it. They were instrumental in being able to allow people to make sure that they didn’t have food insecurity issues, to make sure that the water that they were drinking was relatively clean, to make sure that kids could go to school and that there were shelters in place.

During the war, it became one of the only places that people whose homes have been destroyed or whose cities and neighborhoods were told to evacuate, that they could go to an UNRWA shelter without being turned away. If you go to Gaza right now, like I was in Khan Younis — and I saw an UNRWA school that had been transformed into a shelter across the street from the hospital — what you saw is that it was packed with people, packed with families and children, people who were staying there who were depending on the staff of UNRWA to be able to provide their daily meals.

And I just cannot believe that this sort of response came so quickly. It’s sort of sadistic, in a way, to punish the entire Palestinian population for what are serious allegations, but you’re going to punish 2 million people, and you’re doing it with the backdrop of bombs dropping over them. And you know that many people have fleed and been displaced. And now to cut off this lifeline, I mean, I just find it unconscionable, and I cannot imagine that this is something that was taken so lightly. It’s such a superficial understanding of what UNRWA does, to be able to say, “We’re going to just cut funding,” and not also recognize the implications that it has on all of the population in Gaza right now.

AMY GOODMAN: You were in Gaza when the initial arguments were brought by South Africa against Israel in the International Court of Justice at The Hague, charging it with genocide, and with Israel’s response, saying that they were simply engaged in self-defense. What was the response on the ground of this groundbreaking South African case? How were Palestinians responding to this? And you just returned the day before the ICJ gave their preliminary findings, saying that Israel has to refrain from engaging in genocide.

DR. THAER AHMAD: Yeah. You know, one of the first things that I recognized was that many people felt that the world was listening and that there were some people in the world that were actually considering what was happening in Gaza.

You have to understand, nobody has been untouched by this war. Every single family has been affected. Family members have been killed. Homes have been destroyed. School is paused. Everybody is suffering in Gaza. Everybody is hungry. Everybody is looking where they can get clean water from.

And so, when they heard their arguments being made by South Africa to the ICJ, when they were hearing these things, I remember their responses were, you know, somebody is listening, and somebody is saying what’s inside all of us. Somebody is saying all of the grievances that we have, and they’re saying it out loud, and they’re saying it to the leaders of the world.

And so, there was this — you know, there was this small reprieve in this really horrific war that’s taking place, that, you know, maybe something good can come of this. And so, I remember one of the physicians there talking about the fact that it’s important for people to know that we’re suffering and thinking that most of the world was turning a blind eye to what was happening in Gaza. And this gave them a little hope that there were people who were going to advocate on their behalf.

AMY GOODMAN: Did you see Israeli ground troops? Did you see troops on the ground?

DR. THAER AHMAD: No, I didn’t see any Israeli ground troops. What we did see, right outside the window of the room that I was staying in in the hospital — I slept in the hospital, in addition to working there — is you could see tanks, less than 100 meters away from the window, rolling through. In fact, I saw a direct line of them unearthing bodies from a graveyard. The tank was rolling over it.

And you could feel the shelling. With every single bomb that was being dropped by a plane or the tank shells that were taking place or even the gunfire, the windows would shake. And I remember putting up the mattresses that we had in our call room on the windows, because we were convinced that the window was going to break and that there was going to be shrapnel flying through. We had seen so many shrapnel injuries over the course of the three weeks that we were there. That was one of the main concerns that we had.

So, it was — I didn’t see any ground troops, but I definitely felt that there was this tremendous amount of violence that was taking place, and everybody in the building felt so. There was a sense of pure panic amongst the staff, amongst the people sheltering there, especially in those three nights where you felt like there wasn’t two minutes without a bomb going off or you could hear gunfire.

One of the emergency room department windows was shelled and broken. We saw several different bullets being fired and hitting the wall of the hospital. I remember trying to get service on my cellphone right outside the emergency department and hearing a gunfire and just seeing it hit the wall of the hospital and seeing some sort of, you know, dust emerge from that spot, and realizing, I mean, they couldn’t be — you know, these sort of clashes were taking place less than 50 meters, one block over from where the hospital was. In fact, a house right outside of where the medical complex is was bombed. And as many Palestinians will do, they’ll go straight to where the bombing took place to see if they could find somebody, because they know ambulance services are so limited. And five minutes later, a bomb struck that exact house again, injuring many of the people who were trying to help rescue some of the people there. So, it was pure pandemonium. It was incredibly terrorizing for the people that were there sheltering in and around the hospital.

AMY GOODMAN: This is Muhammad Nasrallah, a displaced Palestinian, speaking from the hospital you worked at, you volunteered at, Nasser Hospital in Gaza.

MUHAMMAD NASRALLAH: [translated] We are suffering here. There’s nothing available — no milk formula, food or medication for children. The hospital is packed, and there are no doctors to treat the patients. And even if medication was available, there are no doctors available.

AMY GOODMAN: So, there we are, looking at Muhammad Nasrallah. He is holding his toddler. We see the hallways are packed. Describe the scene for us. And what kind of medication, what kind of nutrition do you have for patients? We’re not talking about healthy people here.

DR. THAER AHMAD: Yeah. You have nothing, Amy. I mean, you have nothing. What’s happened in Gaza is, especially at Nasser Hospital, when it’s like the sole operating hospital in an area that there’s an intense amount of bombing taking place, is you have to prioritize the people who are injured by these bomb strikes. You have people coming in who have shrapnel injuries, who are on the cusp of death, and you do everything that you can to try to stabilize them, with a minimal amount of resources. I’m talking, you don’t have a catalogue of antibiotics to choose from to protect them from the inevitable infection that they will develop as a result of these injuries. You don’t have pain medicine to be able to give them to help them with their injuries. You don’t have any sort of supplies. And you’re relying purely on the amazing physicians that are there and their sort of creativity and ingenuity to stabilize these patients.

But what you will see as soon as you walk out of what the resuscitation area is, and you look at the rest of the emergency department, or you look at the rest of the hospital, is you will see sick people who are in agony, who are suffering, people who are having heart attacks, people who have uncontrolled diabetes, people who have had strokes, children who are suffering from upper respiratory infections or diarrheal illnesses, who are not getting the nutrition that they need, who are not getting the fluids that they need for the severe dehydration that they’re having. I can’t tell you how many people we saw succumb to these noncommunicable diseases, succumb to these injuries that were not the result of a bomb or a war wound, all of these people who died who, otherwise, if things were just normal, if things were just prewar, they would have easily survived these injuries.

And it reminded me of this sort of concept of excess mortality that we would bring up during COVID. And it’s when your health system is overwhelmed, and you have a ton of people there, you really measure the effect of the tragedy by asking yourself how many people, if we were not overwhelmed, how many people would not have died. And I can promise you that in the Gaza Strip, that that number is astronomically and tragically high. Many people are dying because they are not able to access a hospital that has what it needs to treat them. Simple things, simple infections that would have been covered with an antibiotic, people are dying from them. People are showing up in a time where you could do something about it, and you have to send them home, knowing that they will probably come back and that they will die from this. Children are suffering because of asthma attacks and pneumonia and all of these different infections that we — we just came from flu season here in the United States. And you know that they should not be struggling. And I remember there was an 8-month-old who developed bronchiolitis, which is an upper respiratory infection. And all it requires is monitoring and suctioning the mucus, and really just sort of care that anybody can provide as long as you’re given the resources to do so. And several days later, that child died.

And, you know, that’s — to me, that’s something that’s really the unspoken story here. These are the people that are being neglected because of all of these airstrikes and the tank shelling that’s taking place. And the healthcare system has totally collapsed, and the physicians have nothing to work with. And this sort of suffering is silent. And we’re not able to really measure that in numbers because of everything that’s taken place. And I think that’s something that, in the foreseeable future, once this war is over — and I hope that there is a ceasefire soon, and I hope that aid can enter unfiltered and unrestricted, and that people can get the reprieve that they need — but once all of that is over and we’re assessing the scale of the humanitarian disaster and the humanitarian crisis that’s taking place in Gaza, we’re going to see that it’s on levels that we were unable to even fathom in the midst of the war right now.

AMY GOODMAN: Can you describe pregnant women, women having babies in Gaza?

DR. THAER AHMAD: Yeah. Well, I can tell you a personal story of somebody that I was able to interact with who is a healthcare worker who was pregnant. She knew that she was going to need a C-section. She went and had a C-section done, and it was an uncomplicated C-section. After four hours in recovery, she was asked to pack her things up, to get up and take the newborn baby and go home, because they needed that — they needed to occupy that space with another pregnant patient who was in labor.

There is no prenatal care. There is no postnatal care. There is no ability to be able to handle severe complications. We saw a rise in stillborn births and miscarriages and complications after pregnancy and women who are suffering from bleeding after pregnancy. These are all things that you are — that are taking place with pregnant patients who are having to endure labor in tents and in camps and have no ability to be able to travel at night because it’s too dangerous, no sort of transportation to take them to a local hospital, and a severely limited amount of healthcare facilities that can accommodate obstetric patients or pregnant patients. It’s unimaginable to have to think of what a pregnant woman has to go through anticipating that they’ll need to go into labor soon.

But in those moments where they are able to have labor, that’s not the end of the story. Where they are able to deliver a healthy baby, it’s not the end of the story there. They are still very much in trouble in terms of being able to have the nutrients that they need to be able to feed their children and to feed themselves to be able to take care of their children. It’s staggering how many — the lack of sort of capabilities that exists in the Gaza Strip right now as a result of this war for the over 50,000 pregnant women that are there. And it’s very concerning to think about aid being restricted or not being able to deliver, especially if some of these neonates or these infants and newborn babies would need formula or they would need any sort of care. I mean, there are over 150 newborn babies in incubators in the Gaza Strip right now, and all of them are at risk because of the lack of electricity, the lack of the medications that are there.

AMY GOODMAN: And according to UNICEF, a baby is born in Gaza every 10 minutes. Can you talk about why blackouts are a health issue, like the telecommunications blackouts, whether it’s calling for an ambulance or people trapped under the rubble, why cellphone service isn’t about calling your friend to gab?

DR. THAER AHMAD: Yeah, yeah, absolutely, absolutely. I mean, I think that’s such an important point. When we say that every single aspect of life in Gaza has been under attack and has been disrupted, telecommunications is a perfect example of that. The Israeli military has told the civilians in the Gaza Strip that they will designate these safe zones. If there is no cellular service, if there’s no access to internet, how on Earth is any single person in the Gaza Strip supposed to know where is somewhere that’s safe? Are they supposed to just hope that they can hear it over an intercom that’s being blasted from a tank, or it’s supposed to be a flyer that’s dropped, they’re supposed to be able to read that and understand that they can get themselves and their family to safety?

In addition to that, what if somebody is injured or somebody needs to have some sort of care take place? There is no communication that can take place with the very few specialists that remain in the Gaza Strip. We cannot expect specialists like vascular surgeons, that are in short supply — maybe there’s one or two left in the Gaza Strip — to stay only at one place at all times. We want to be able to communicate with them to be able to have them access and treat as many patients as possible in the Gaza Strip. If you go eight days, like I did in the Gaza Strip, without any telecommunications, how can physicians or healthcare workers or first responders or ambulance drivers communicate with each other and figure out how to safely deliver care or how to rescue somebody so that they can get timely care?

You know, when it comes to trauma, there’s this thing called the golden hour. And essentially, you have to take advantage of every single minute in the first moments after there is some sort of trauma that takes place, from a bomb blast or from an airstrike. And I can tell you, in the Gaza Strip, those delays are taking place because of things like a lack of telecommunications, by no area being safe enough to be able to transport an ambulance to pick somebody up.

And I think, you know, the second part of this that people should also understand is that there are several people who have been initially injured in Gaza. They have — their initial care was taken care of, but they need follow-up care. All of these amputees that you hear about, all of these wounds that have been suffered, they need really close follow-up and care. And some of them need to be transferred out of the Gaza Strip. That’s not happening at all. And what happens to many of these people, many of them, is that they will suffer from a very slow and painful death, either from infection or some other injury resulted from this. And if they do not die and they’re able to survive, like many of them will, many of the things that we could have done to help improve the quality of life, that that moment will have gone and that they will be — they will have some severe disabilities as a result of this for the rest of their lives. And so, these are all ways that have contributed to the suffering of the Palestinian people in Gaza. And it’s something that continues to this very moment, and it only intensifies with every passing day that goes by.

AMY GOODMAN: In November, Dr. Hammam Alloh was killed when an Israeli artillery shell struck his wife’s home. It killed him, his father, his father-in-law, his brother-in-law. He was a kidney specialist who worked at Al-Shifa, the largest hospital in Gaza. He was 36 years old, leaves behind his wife and two children, a 4- and 5-year-old. We spoke to Dr. Hammam Alloh on October 31st in one of his last interviews

DR. HAMMAM ALLOH: And if I go, who treats my patients? We are not animals. We have the right to receive proper healthcare. So we can’t just leave. … You think I went to medical school and for my postgraduate degrees for a total of 14 years so I think only about my life and not my patients? I’m asking you, Ma’am. Do you think this is the reason I went to med school, to think only about my life? This is not the reason why I became a doctor.

AMY GOODMAN: That’s Dr. Hammam Alloh. We spoke to him October 31st. He died in an Israeli artillery strike, checking on his family 10 days later, Dr. Thaer Ahmad, talk about your colleagues in Gaza. You’re just back from spending three weeks at Al-Nasser, at another hospital. This one’s in Khan Younis. Dr. Alloh was at Al-Shifa. I mean, what he describes and why he says he went to medical school, he was responding to my question about why doesn’t he just leave.

DR. THAER AHMAD: Yeah. He reminds me of every other healthcare worker in Gaza right now, many of the physicians. And I remember that interview, and I remember his tragic death, him being killed in an airstrike.

I want to just mention that he’s one of few kidney specialists in all of Gaza. There are over a thousand patients in Gaza that require dialysis because they have kidney failure. And in my first two days at Nasser Hospital, there was a 16-year-old who was on dialysis, who ultimately died because he was not getting the amount of dialysis that he needed. And I can guarantee you that if Dr. Alloh was still alive, that this patient would have been saved.

What they’ve had to do in Gaza, especially when it comes to kidney patients, is they’ve had to decrease the amount of time that some of these kidney failure patients can get dialysis, because they need to accommodate more and more people who have been displaced. And again, what happens is, you have all of these very, very difficult diseases, these noncommunicable diseases that get worse, and you have tragedies like this.

I’m working with people in Gaza at Nasser Hospital who for four months they have not had a paycheck. They also are looking for food distributions and for ways to get clean water for themselves and their families. Their families are living in tents, or they’re living in the hospital. They themselves are living in tents, or they’re living in the hospital. And we’re asking them, day in and day out, to come in and treat many of the wounded. And this is not, you know, a typical shift that you would have in the States or anywhere else where you are able to accommodate patients as they come in. There are waves and waves of trauma patients coming through that require intense care, that need absolute focus and all hands on deck. And we continue to see that we’re pushing a lot of these physicians there to accommodate as many of them as possible, with few resources, with no opportunity to be able to deliver the care that they want to deliver. So many of them were at different hospitals, as well, that came to Al-Nasser after those hospitals were raided or they were shut down. Many of them had been incarcerated for — or, they had been in prison for a couple of weeks and eventually let go. They are subject to just the same amount of tragedy and human suffering as the rest of Gaza, but still they show up to serve their people. And they do it in a heroic fashion, and they do it with such grace. And they are so skilled and so talented, and they have an incredible amount of knowledge and experience.

But I am so concerned about what we keep asking them to do. And I think that the humanitarian community — and I think it’s well acknowledged, is that we failed many of the healthcare workers and the humanitarian aid workers in the Gaza Strip, that we failed them that over four months we’ve not been able to provide any sort of relief, that they are able to take a break from the constant trauma that they’re seeing. And we’re asking them to do so as if, you know, this is a job that they’re getting paid or that their accommodations are taken care of or that we can guarantee their security. But none of that is true. We can’t guarantee the security of any healthcare worker in Gaza, let alone any person in Gaza. We can’t guarantee the security of any child in Gaza. And so, you know, I can’t imagine what sort of person it takes to have the resilience that it does. But I met these people. And, you know, they are an absolute inspiration to the world about what it means to be a hero, an actual hero. And I’m just concerned that we keep asking them to keep doing more and more, in a place where the healthcare system has collapsed, where all of the infrastructure that exists has been damaged or destroyed. And we’re asking them to do the impossible, and we keep doing so every single day.

I think one one last thing I’d mention about the healthcare workers in Gaza is that, you know, I got a text message this morning on my way here to do the interview from one of the ER doctors that I was able to work with. He lives in Rafah, but he would commute to Khan Younis every single day. And he was distraught. His name is Dr. Majdi. He was distraught at not being able to reach the hospital and deliver care to patients. And he was asking me to connect with any NGO that I could connect him with to see how he can still do his job, how he can still serve the people of Gaza. And that’s the kind of people that we’re talking about in terms of the healthcare workers that are there or the humanitarian relief workers that are Palestinian that are trying to serve their people in Gaza. They exhibit just, you know, exactly what Dr. Alloh was saying. They’re not going to desert their patients, and they know that it could cost them their life.

AMY GOODMAN: Dr. Ahmad, I’m wondering how you got into Gaza and how you got out. How many volunteers are coming in to help at the hospitals?

DR. THAER AHMAD: Yeah. So, what we were able to do, MedGlobal joined the WHO’s emergency medical teams in order to get in and access Gaza and be deployed or tasked at different hospitals that had major needs. We were a group of five from MedGlobal in a total of probably 20 or so NGO workers, medical professionals, aid workers that were able to access Gaza in January. We were probably the second or third delegation to enter. You know, I would say that the end of December and the beginning of January is the first time NGO workers were really able to enter Gaza and be able to be tasked with ways that they could deliver care or they can deliver aid to people.

It’s nowhere near enough. I know that the needs are very, very high in Gaza. I was able to confirm them. That’s what they’ve been communicating to us the entire time. There is a lot of restrictions that are in place that are preventing people from getting the aid that they need and the medical care that they need. And I’ll give you one example. Many of the people in Gaza have been subject to these quadcopters, these kind of drones that are able to fire these bullets at them from the sky. And so many of them have been victims of this. And, in fact, many young men I saw had these jaw injuries where their jaw was totally shattered. Well, you’re able to do surgery and try to fix this, but you need plates or you need screws. And many of the surgeons that were there told us that that has not been allowed since the war started, that they don’t even have the materials that they need to be able to repair somebody’s jaw. And I think most of us can understand that if your jaw is totally shattered, that that compromises a lot of things that you’ll be able to do to stay alive. That compromises your ability to be able to eat or drink any water. So, small things like this, where you are sort of restricting any sort of screws entering to fix a hip fracture or a plate that you could fix a broken bone or a broken vertebrae, they have very serious implications for the people there, and they could cost them their lives.

And that’s something that — we’re almost at four months of this war — still has not entered, in addition to things like a portable refrigerator, where we can keep vaccines, so we can vaccinate many of the children, many of the children from measles or mumps or chickenpox, or, you know, store medicines that need to be refrigerated, maybe like insulin or any of these other medicines. All of these things are being restricted. And so, it’s been very, very difficult to be able to not only access and get inside of Gaza, but to bring many of the supplies that are needed. We know what the needs are. It’s been communicated very clearly, and it’s been very accurate. But there are multiple barriers in place that are preventing this and that continue to contribute to the suffering that’s taking place.

AMY GOODMAN: What is the scene like at the crossings to get out? Did you go through Rafah, for example? We’re hearing about people having to pay thousands of dollars, thinking they’ll be able to get out, but it’s a scam.

DR. THAER AHMAD: Yeah, absolutely. So, that’s definitely true. We entered through Rafah crossing from the Egyptian side into Gaza. One thing you’ll notice is, if you’re entering from Egypt into Gaza, it was not very busy. The other thing that you notice is that there are hundreds of aid trucks just waiting, parked at the border. And in speaking to people there, these trucks have been there for days. And you know that these trucks contain the aid that the people need to survive. We’re talking about flour. You’re talking about bottled water. You’re talking about even tents or materials that they could use as a tent. And so, we just — that’s the first thing that hits you.

And the second you cross, once you see the Palestinian side, where Palestinians are trying to come in from Rafah into the Egyptian side, you see that it’s crammed with people, people who are trying to be able to cross to safety or to get medical care. I spoke to several people, several physician colleagues or nurses who were also trying to get family members out. And they said that at that time, which was about five days ago, it would cost, for each individual, 10,000 U.S. dollars to be able to get them out. And as you said, some of these are scams. Some of it works, some of it doesn’t. But Gaza is already a place that was very impoverished, and you’re talking about people who have not been able to work for four months. Who has $10,000 lying around that they’d be able to get the life-saving care that they need, or that they would be able to go and seek refuge because there is no place left for them in Gaza that they’ll be able to set up a tent or they’ll be able to stay with their family?

And that’s, I think, part of, you know, what’s so tragic, is hearing people have no option. So, you’re asking them to move, you want them to leave, but there are no real options. And that border is, essentially, for people crossing, everyday people to cross, it’s closed. I mean, there are — on our way out, when we were leaving from Rafah into Egypt, I remember seeing that there were several ambulances ready. And there are over 50,000 wounded people in Gaza, thousands of whom need to be transferred outside of Gaza to other places so they can get specialty care. And I remember on the day that we left, that total number was 11 people, 11 people who are crossing out of Gaza into Egypt to get medical care. And I know that there are thousands and thousands waiting on the list.

And there’s a famous video that many people shared in Gaza with me about a man whose child was on this list, and he was ripping up the transfer paper, because his son had died waiting for him to be on that approved list to be transferred out. And I think that’s something that is really hard to live with. It was hard to see. There’s, you know, a tremendous amount of survivor’s guilt that you have crossing over so easily and knowing that there are people who are injured, who are suffering, who need to get specialty care, and who are just waiting for a list to pop up and have their name on it, and knowing that there’s —

AMY GOODMAN: Who determines whether they can get out?

DR. THAER AHMAD: You know, speaking to everyone there, it seems like there’s a list that’s produced every single day by the Israelis, that’s passed to the Egyptians, and from the Egyptians, it’s passed to the Palestinians. And I think multiple people who are getting these sort of referrals, medical referrals, what they’ve had to do is go every single morning to the crossing, which is not easy — you have to understand there’s no fuel in the Gaza Strip, so there’s not modes of transportation that are cheap to be able to get to the border — and just find out if they’re on that list in the morning, every single day they’re waiting to do so. And they’re not doing so hoping that they can cross over and go on vacation. They’re doing so because their life depends on it. They’re doing so because a family member is extremely sick and needs to get the care. Or they’re doing so because they are — there is a chance that they could die if they’re not able to cross over.

AMY GOODMAN: Dr. Ahmad, I wanted to ask you about dirty water, what this leads to when you don’t have access to clean water, and also on the whole issue of infection. And so often I will see someone interviewed, and I’m not talking about — I mean, in Gaza — I’m not talking about U.S. television — and they’re not talking about this particular issue, but the issue of famine. They’re talking about another issue, but I see how thin they are, how their teeth are, you know, are sticking out, their lips are receding. That issue of famine and how that, too, aside from famine being a threat to someone’s life, leads to disease, breaking down your immune system?

DR. THAER AHMAD: Yeah. These are really important points. And what we’ll start with is the water aspect of this. Many people in Rafah, where there are now over 1.7 million people, what they depend on is a truck that’s driving around that has a big barrel of water and that has a hose sticking out of it, so they can fill containers of water in it. That water, if it’s tested, I really, really doubt that it is fit for human consumption. And what I mean by that is the salt levels in it may be high, or it may be contaminated with something that would suggest that it’s not pure, clean drinking water.

As a result of that, what will happen is you will have disease begin to spread for multiple reasons. Number one, if the water is not clean, it’s contaminated. You can get diarrheal illnesses. And then if you don’t have enough water to be able to have proper sanitation, that will run through many of these crowded shelters and crowded camps. And we’ve already seen a hepatitis A outbreak. We’ve seen many diarrheal diseases. And, of course, we see a lot of these respiratory infections spread through the camps, because people have to walk 10 minutes or they have to wait 30 minutes just to be able to wash their hands properly. And even if they wait that long and they show up to a sink in a shelter, or sometimes this is what would happen to us in the hospital, you turn on the faucet, and there’s no water coming out of it because the water has run out for the day. And you have to wait until tomorrow until you hope somebody delivers more water. These are very serious issues that will contribute to the spread of disease.

And the World Health Organization has estimated that they believe more people will die from these sort of communicable diseases that are spread like this, because of a lack of sanitation, than people who have been killed in the war. And you know just as well as I do, we’re already exceeding 30,000 people who have been killed in this war. To think that there could be more people die as a result of these diseases is something we know is preventable.

And you’re absolutely right when it comes to hunger. The food insecurity and the hunger levels are real. We experienced it there. We could tell that people are hungry. And every single person that we spoke to, who would show me pictures of Gaza before the war and how beautiful it was and how the coastline looked, every single one of them looked like they had lost at least 15 to 20 pounds. And they are ready to admit that. Many of them are surviving off of cans of beans that they’ll have. The World Food Programme did an assessment back in November about how families were coping. And they found extreme coping mechanisms when it came to hunger, adults skipping meals, sometimes for 24 hours at a time, children having to eat less portions and less times during the day. These are things that are not just — you know, we’re not just talking about famine and food insecurity. This is a public health disaster. This is something that will cause people to not have strong immune systems, will stunt their growth, and will decrease their energy and their exhaustion levels. It will affect all parts of their life.

I want to mention one thing about that assessment that the World Food Programme did, and this was specifically for people in the north of Gaza. This is how extreme the situation has gotten. They asked adults in the household, “How often did you skip food for an entire day during the last month?” And they found that 90% of those households, those adults, said, “We did that more than 10 times in the month, where we did not have a single thing to eat for 24 hours.” Everybody in Gaza is experiencing hunger. Nobody is spared from that. And every single person in Gaza is also looking for clean and reliable water. Even hospitals are not able to secure the right amount of water. I remember treating several patients and going to the faucet area, trying to wash my hands, and realizing there’s no water there, and having to use iodine or sanitizer or something that I wouldn’t normally do here in the States, knowing that I have access to water. And that is not something that should be glossed over, because it has very serious health implications. And it’s something that, again, could cause and lead to death that should be, in almost every circumstance, preventable.

AMY GOODMAN: Which brings us back to UNRWA also, any kind of large agency that spreads across Gaza that can deal with all of these issues that are across Gaza. Can you talk about how it links, the hospitals, the schools, the clinics?

DR. THAER AHMAD: I mean, without organizations like UNRWA or other NGOs, if they are somehow — if they’re also under attack, or if they are being compromised in their ability to deliver aid, if you put that in the context of what’s happening in the war, where all of civil society has essentially fallen, all of the normal services that would be provided are no longer present, and now you’re taking away the lifeline that’s there, you’re talking about total chaos, in a situation that’s already very chaotic and disastrous.

All of these organizations try to work together to fill in the gaps, and they’re not able to fill in these gaps. They’re not able to address the food needs and the water needs, let alone the shelter needs. I mean, UNRWA has over 150 shelters, with over a million people in them. And they are four times over capacity. In some cases, they’re seven times over capacity. What that means is that you don’t have enough water to go around. You don’t have enough toilets to go around for people to be able to appropriately use those facilities. You don’t have — a shower is out of the question.

And you’re compounding that with many of those facilities not just being said that the funding is going to be halted. But UNRWA can tell you about over a hundred instances where their installations, their temporary and permanent shelters, were hit and attacked. There are over 300 people that were killed in these UNRWA shelters that were trying to seek shelter there. Over 150 of these UNRWA workers have been killed in the process.

So, on top of all of that sort of violence and the lack of security that exists there, we’re now saying that this organization, which has been one of the main, main aid distributors, regardless of where the aid is coming from or what organization is providing the aid, UNRWA is one of the main ones that’s able to get it distributed to people who are in need. Now we’re suddenly saying that we may take this away, and we’re going to take it away at a time where this humanitarian crisis has exponentially gotten worse, because of how long it’s lasted and how severe the restrictions are. And people have nowhere to go.

I want to mention something about our organization. You know, we work in several different areas. MedGlobal has worked in Ukraine, in Syria, in Yemen, in Sudan, in Colombia, at the south of our border here in the States. And we’ve seen really tragic humanitarian crises. Gaza right now, in its current form, is the worst humanitarian crisis we have ever seen, just based on the things that I just mentioned. What we’re saying is, places like or organizations like UNRWA, a U.N. agency that’s providing relief for the worst humanitarian crisis we’ve ever seen, that that may go away at the end of February. They’ve said that already they don’t have enough funding to provide services in February to be able to meet all of the needs. And that’s before any sort of pause in funding. If they run out of money in February, and, come March, UNRWA is not able to deliver any sort of care, any sort of aid to the people that are in Gaza, I don’t want to think about what Gaza would look like. I cannot imagine the hell that it would become, if we’re able — if we, basically, cut off that lifeline.

AMY GOODMAN: Dr. Thaer Ahmad, you are an emergency room physician. You’re just back from Gaza. You work with the World Health Organization. You’re global health director of your hospital, assistant professor of emergency medicine at the University of Illinois, Chicago. What are you teaching your students? What are you telling your colleagues right now as you return?

DR. THAER AHMAD: Well, you know, I — and, you know, it’s — it feels really, really tough to say this out loud. But what I found is, while we are trying to focus and highlight the humanitarian crisis that’s taking place in Gaza, especially from an impartial, neutral, apolitical sort of perspective, I found that a lot of opportunities have been where I could educate people on what’s happening, and we can start thinking about ways that we can contribute to alleviating the suffering — I found that a lot of opportunities have been stifled. I found that there has been a lot of politically charged discussions in regards to that. And that is an incredible disservice that I had never experienced before. I’ve been working in humanitarian relief since 2008. And I’ve never seen anything like this, where even trying to shed light on what’s happening in Gaza is something that becomes some sort of political discussion or conversation. And so what I’ve tried to do —

AMY GOODMAN: Can you be more specific?

DR. THAER AHMAD: Yeah. Well, what I can tell you is that many organizations, specifically the Illinois College of Emergency Physicians, felt that it was not appropriate for us to call for healthcare worker protections. In May, I was able to go to Congress to advocate with the American College of Emergency Physicians, and we were able to go to offices and say, “We think healthcare workers should be a protected class in America,” meaning that, you know, they should not be — that any sort of assault that takes place on them should not be taken lightly, should be a federal offense, for that matter. When I thought that we can draw parallels to what’s happening in Gaza — and you mentioned how many healthcare workers have been killed: Over 300 have been killed in Gaza — and I said, “Can we at least say that maybe healthcare workers should be protected, hospitals should not be a target?” I was met with resistance to that, and I was met with talks about some sort of political discussion taking place and terrorism and terrorist organizations. And for me, that derails the conversation in a way that doesn’t allow you to take it a step further and really show the degree of the humanitarian catastrophe that’s taken place.

And so, what I’ve had to do in the process is remind people first the facts on the ground and talk about Gaza before October 7th. We have to realize that Gaza was a place that had many struggles. And we know that it’s over half of its population are children. And we know that the availability of essential medicines prior to October 7th was less than 90%, was less than 80%. It’s around half, half of essential medicines for blood pressure medications or diabetes medications. This is all before the war. And so, this is something that people need to understand. We hear from Oxfam that 95% of the water was not fit for human consumption before October 7th. What about right now, when water is in scarce supply, and you hear about people having to — are trying to drink water from the sea? I try to remind people that Gaza was at a electricity deficit, that there were rolling blackouts. Well, now you’re talking about four months with no electricity whatsoever, and how that would translate into daily life and how that affects people.

So, it’s really about trying to educate people about Gaza before October 7th and allowing them to connect the dots, that what’s happening right now is a recipe for disaster. It has been this incredible amount of human suffering that has taken place. And it’s unfortunate that we have to start with trying to get people to understand that human beings are the people that occupy Gaza right now, that people that are living in Gaza are also human beings, this is what their struggles looked like before, and this is how these struggles have been compounded by what’s taking place now.

AMY GOODMAN: We’re talking with emergency room doctor Thaer Ahmad, just back from Gaza. And before we go, I wanted to ask you about — well, you were born in Chicago, your parents born in the West Bank. Can you talk about the news from there and what you understand is happening with your family?

DR. THAER AHMAD: Yeah, I mean, I was able to speak with my family. Especially when they heard I was going to the Gaza Strip, they were very concerned. But after coming back and just touching base with them, you know, the West Bank, it seems to be just as — I don’t want to say “just as.” What I’d like to mention is that it sounds like there is a lot of instability going on in the West Bank. And I can only share with you what my family is sharing with me. And that’s concerns about their safety of being able to go to work every single day because of increasing settler violence that’s taking place, concerns about the ease of movement because of random checkpoints that are popping up and causing delays in them being able to go to school or delays in them being able to go to the market. Really, there’s a significant amount of tension that everybody is feeling. And it feels like things are going to erupt and are heading down in a direction that’s going to lead to total chaos.

It’s not the same as what’s happening in Gaza. Of course, Gaza is this sort of pure military assault that’s taking place by a very strong army. But there are raids that are being conducted every single day in the West Bank. It has been the deadliest year last year. 2023 was the deadliest year in over a decade in the West Bank. My cousin, who is a photographer, was shot in Ramallah while he was trying to take pictures of a protest that was taking place. He was shot by an Israeli soldier. Thankfully, he’s doing OK, and he’s recovered. But that’s sort of what they’re being subjected to. And I know that it’s not in the news cycle, because of the devastating thing that’s taking — because of the devastation that’s taking place in Gaza. But this is something that I also think is leading down a path of more violence, of more suffering. And I’m very concerned about where things are headed.

I was just in Taram, which is where my family is from, in August. And even then, moving around, prior to October 7th, was much more difficult than I ever remember it being. And the situation was already very tense, with many of the military activities that were taking place in Jenin, in Tulkarem, in Riha, in Nablus. All of these Palestinian West Bank cities were subjected to lockdowns and military raids. And so, it’s a very uneasy feeling. Things are deteriorating in the West Bank. And it just seems like any sort of idea of home for Palestinians is being compromised every single day and is shrinking every single day. And so, I think that’s, of course, something that concerns all of us, all — everybody in the Palestinian diaspora and everybody in Palestine.

AMY GOODMAN: Dr. Thaer Ahmad, I want to thank you so much for being with us, emergency room physician, spent three weeks in Gaza volunteering at Al-Nasser Hospital in Khan Younis, board member for MedGlobal, which has an office in Gaza and is working with the World Health Organization. He just returned to Chicago Thursday, where he’s the global health director of his hospital, also assistant professor of emergency medicine at the University of Illinois, Chicago. To see Part 1 of our discussion, go to democracynow.org. I’m Amy Goodman. Thanks so much for joining us.

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