Nursing through crisis - 36 days in Gaza

Author: JP Miller, International Committee of the Red Cross and Australian Red Cross delegate

I arrived in Gaza in February 2024, deployed to the European Gaza Hospital by the International Committee of the Red Cross (ICRC). Located in Khan Younis, in southern Gaza, our mission was to provide surgical care for weapon-wounded individuals alongside local medical and healthcare professionals. 

Despite more than 12 years of experience as an emergency nurse and a history of deployments with the Red Cross Red Crescent Movement to South Sudan, Bangladesh, Myanmar, Syria, Papua New Guinea and Nigeria, Gaza was like nothing I had seen before.

Upon arrival, I was struck by the overwhelming sight of humanitarian aid trucks lined up at the Rafah border and the sheer number of children in the hospital. Tents and temporary structures filled every available space within hospital grounds, and families sought shelter and privacy wherever they could. Our ward was no exception, with patients and their families sharing cubicles, adding to the chaos and complexity of the work environment. The sounds of gunfire and bomb blasts were a constant backdrop to us in the hospital, although after a few days they blended into the white noise of our surroundings.  

The majority of our work was carried out alongside national volunteer nurses, many of whom were new graduates working 24-hour shifts. These nurses had been internally displaced themselves from elsewhere in Gaza and had suffered their own personal traumas, losing loved ones, friends, and colleagues. Despite this, they continued to turn up each day to provide nursing care for patients. Witnessing their dedication and resilience was both humbling and inspiring.  

Shortly after my arrival, the Nasser Hospital in Khan Younis was besieged, rendering it nonfunctional. European Gaza Hospital became one of the last operating highly specialised hospitals, and the influx of patients strained our already limited resources. We regularly worked 10–12-hour days and, due to frequent electricity interruptions, would often end up working under torchlight. We experienced shortages in all medications, supplies and consumables. Infection control was challenging, with limited fresh water and inadequate sanitation infrastructure. 

The heartbreaking challenge of working in a resource-constrained environment like Gaza is that it significantly impacts and limits the care that healthcare workers can provide. Often when we deploy, we bring pre-existing expectations to the field of what good medical care looks like, and when it looks different, or can't be achieved because of these limitations, we question whether or not we are making a difference. 

Before I departed Melbourne, a senior trusted colleague put me in contact with an experienced humanitarian. We had a last-minute phone call before I left, and she told me that whilst I'm away I might feel like I'm not doing enough. She encouraged me not to dismiss the value of just being there, and the value that can be gained from small actions that are a drop in the ocean of all that is needed. Being there to help support national staff who are no doubt exhausted. Being there to listen to the stories of local colleagues and patients. Sharing their stories and highlighting our shared humanity to the world.  

The more I reflected on this whilst in the field, the more I appreciated what my colleague meant. Small actions that help alleviate any amount of someone’s suffering are of great value, even as the needs remain overwhelming in Gaza. Which is why, despite the inherent difficulty of capturing and conveying my experiences into a tangible and authentic piece of writing, I’m committed to share it.  

Since coming home from my first deployment to the Middle East, family, friends and colleagues have all asked me: “How was Gaza?”  

It’s not a simple experience to impart on others in conversation. Ultimately, the question is best answered through the stories and experiences of the Palestinians themselves. Week after week, patients would talk to me about their lives before the war, showing me photos of their houses and family members that they had lost. Many expressed a desire for the hostilities to end so they can rebuild their lives, but the uncertainty surrounding the future was palpable. My emergency nursing background meant I wasn’t accustomed to caring for the same patients for days to weeks, and despite the language barrier, each day we communicated and bonded slightly more.  

There was a 50-year-old man who proudly showed me a video of himself working as a butcher before the war. Several patients gathered around his mobile screen, watching him cut large slices of beef—such a meal being difficult to imagine in the moment. Whilst maintaining his infectious smile he pointed to his right leg in the video, this leg was now amputated above the knee and he suffered from neuropathic pain. He shrugged at me and said "inshallah” (God willing).   

In the next room was a patient who spoke very good English, a kind and quiet soul. He often acted as an informal translator, expressing the concerns of other patients on the ward. He told me how his house was bombed, and he sustained burns and a broken arm. His two cats died in the bombing. He would frequently recount his memories of beautiful places in Gaza to me, only to recall that everywhere was now in ruins. The grief in his words was near unbearable. 

Across the ward was another elderly man with a large wound requiring ongoing debridement (the process of removing dead, damaged or infected tissue from a wound to promote healing). His son slept on the floor next to him. They would cook on the floor and gesture for me to take some food. Given the food scarcity that people in Gaza currently face, it was beyond generous. Patient nutritional levels were inadequate due to the lack of fresh food and the increased metabolic demands associated with injury. I would always gently refuse, not wanting to take anything away from them.  

A few beds down there was a patient who had been transferred from another hospital months ago with approximately 20 per cent total body surface area burns. He had undergone dressing changes and operations without any anaesthesia. This trauma had impacted him heavily, and he was now extremely sensitive to any painful stimuli. Despite his wounds being nearly healed, he continued to suffer significant pain and anxiety. I would premedicate him with analgesia before dressings and then we would practice deep breathing with his eyes closed as I cleaned his wounds. Shahir (Breathe in), Zafir (Breathe out). It was painful for him but he managed with remarkable resilience.   

I predominantly cared for the adult male patients on the ward, yet our wing also housed women and children. As a healthcare professional, it is always a challenge to come to terms with and care for paediatric war injuries. The vulnerability and innocence of a child is never clearer nor more disconcerting than in the setting of conflict.

One of the most confronting cases I cared for, concerned a 6-year-old boy who came to us from northern Gaza. His family’s home had been hit in an airstrike 2 months previous. His mother died. He was hit by a piece of shrapnel. It entered lateral to his right eye and lodged itself below his left eye socket. It took two months for this young boy to be able to access medical care to remove the piece of shrapnel. It had already caused him a lot of damage. He lost his right eye and had no vision in his left eye. He suffered a brain injury and multiple facial fractures. Despite the continual presence of his father, he kept calling out for his dead mother as would any child whenever distraught. It was an incredibly heart-wrenching sight.  

I only spent 36 days in Gaza on this first deployment, and while my experience was harrowing, it should not be equated with the ongoing conflict endured by the civilians and local workers who remain on the ground. The needs of people in Gaza are overwhelming. Continued hostilities further drive displacement and impact access to healthcare and the functionality of health services.

The provision of humanitarian aid and unimpeded humanitarian access is of the utmost importance. International humanitarian law, known also as the laws of war, exists to limit suffering in times of armed conflict, must be respected and followed by all parties —especially when it comes to the protection of healthcare facilities and civilians.  

The presence of the ICRC at the hospital appeared to bring a sense of security to patients and staff alike. In a situation rife with uncertainty and chaos, being able to help make people feel safer should not be undervalued. After returning home in July 2024, the European Gaza Hospital was evacuated and no longer functional; it has only recently resumed partial operations.

In the interim, the ICRC, along with 12 National Red Cross and Crescent Societies, including Australian Red Cross have stood up a 60-bed field hospital. This new hospital supports local health services as the health system struggles under the weight of ongoing conflict.

Having seen the human devastation in Gaza firsthand, my thoughts will stay with the displaced, our patients, and our local colleagues still on the ground.