Explosions rattle a Red Cross field hospital in Gaza, as medical staff prepare for influx of injured

By Dr Sandy Inglis

The explosions are the cue.

Boom. And again: Boom.

A mass casualty influx is imminent.

In recent days in the coastal area of al-Mawasi, on the southern end of the Gaza Strip, dozens of people were killed and scores injured when hostilities reached a displacement camp near the premises of the International Committee of the Red Cross (ICRC). Next door, the Red Cross Field Hospital where I work began receiving patients within minutes.

I had been sitting in the admin area of the hospital, in a meeting about staffing and rosters when we heard a particularly loud explosion.

The wave of sound hit me. The hospital’s tent walls jerked as the shockwaves reverberated. We realized what would be coming, and most staff – local Palestinians and international – went to the emergency department to prepare.

But there was no time. In the chaos of war, you adapt.

I stood at the hospital entrance as ambulances came screeching in, at times literally sliding to a stop, with paramedics piling out to grab the stretcher, directing each patient to the area of our hospital that they needed to go to, categorized by colour.

Red area: A young man with an arm dangling by threads of skin from the shoulder, shrapnel wounds across the chest and stomach. Immediate attention needed. Life at risk. Amputation likely.

Yellow area: A toddler screaming in pain, all limbs attached but a clear fracture, bleeding from shallow cuts. X-ray and splint required, maybe stitches.

The morgue: A corpse, burnt so badly as to be unrecognizable, wrapped in a sheet.

On this day, more than 50 wounded patients arrived at our Field Hospital, and despite our best efforts, eight of them died after their arrival. The bodies of 14 people already dead also were brought to us.

The doctors and nurses that I work with, both local and international staff, aren’t strangers to mass casualty events – critical situations that typically overwhelm the standard equipment and staff levels. Sadly, in a span of five days over the last week we had three such events.

When they happen, we focus on the job at hand – treating those who need it. Inside hot tents, you analyse, you operate, you stitch.

Not far away are the gunshots and explosions, adding an element of fear for patients who have already lived through horror. Those that are conscious may be panicked or scared. Some are blank — in shock — or are yelling for family. Some need to be sedated.

After helping one patient, it’s on to the next bed. Assess, take readings, set a cast. Then the next. All around you family members are screaming, people grieving, bystanders shouting. Staff, though clearly traumatized, continue working.

People view hospitals – even ones made of canvas and tarpaulin – as havens of safety during war. Under international humanitarian law, hospitals are protected locations, so that those who need it can get medical attention and treatment.

In a place like Gaza, where no civilian feels safe, this creates a catch-22 situation. People want to be close to the hospital, so they feel less exposed. At the same time, we have limited space and are trying to respond to large-scale emergencies where the lives of dozens are at risk.

Usually before a major influx of casualties, you have time to gather staff and assign roles, set up triage beds and mass casualty boxes with extra equipment, give a quick situation update of what’s coming. But last week, because the explosions were so close to the Field Hospital, patients began arriving within six minutes.

The injuries were like those we have seen continually since the Field Hospital opened in mid-May and that have been seen across the entire Gaza Strip since October. Some can physically recover; some will live without a limb. But the mental toll, particularly for kids, is so heavy it will remain for years to come. This is always a huge worry, and one that stays with me.

Some of those injured last week will need more surgeries. Many will need physiotherapy and mental health support to recover.

After the patients have been attended to, we clean up, we repack the mass casualty influx boxes with fresh equipment, we speak to family members, and we debrief.

Then we get ready for the next one.

___

The 60-bed Red Cross Field Hospital is a combined effort of the International Committee of the Red Cross (ICRC) and 12 Red Cross National Societies , together with the Palestine Red Crescent Society (PRCS) to help address the overwhelming medical needs in Gaza. It opened in mid-May close to the city of Rafah.

A native of South Africa, Dr. Sandy Inglis is the Field Hospital’s senior medical officer.