On May 1, 2024, a medical mission organized by U.S. medical nonprofit FAJR Scientific embarked on its second trip to Gaza since the start of Israel’s genocidal assault. The medical team first resided in a safe house in West Rafah and operated out of the European Gaza Hospital (EGH) between Rafah and Khan Younis in southern Gaza. The team's two-week mission was rapidly disrupted by Israel’s ground invasion of Rafah on May 6. As Israel’s indiscriminate bombing campaign encroached on the West of the city, FAJR’s team evacuated from their safe house to EGH on May 9, receiving official evacuation orders from the Israeli Occupation Forces the following day. Israel’s closure, and subsequent destruction, of the Rafah border crossing trapped the FAJR team until safe passage was granted by the State Department and WHO (World Health Organization) eight days later.
Prioritizing their commitment to care in Gaza, the team continued operating on patients who direly needed them. They eventually evacuated on May 17. During this time, the medical staff on mission witnessed the increasingly apocalyptic conditions throughout Rafah, testifying to the kinds of traumatic injuries sustained by civilians as a result of Israel's assault, incessant massacres across the alleged safe zone, and the complete devastation of Gaza’s health care system. Palestine Square spoke with Emergency Registered Nurse (RN) Abeerah Muhammad as part of a series of forthcoming testimonies from this cohort which recounts Israel’s ground invasion of Rafah.
Abeerah Muhammad is an Emergency and ICU RN based in Dallas, Texas. Muhammad received a B.S. in nursing from U.T. Arlington and a Master’s in Nursing Education from Western Governors University and has been practicing for nearly eight years as an RN and an EMT before that. Muhammad has trained in disaster relief with the American Red Cross and Federal Emergency Management Agency (FEMA) working on domestic cases in Texas, particularly Hurricane Harvey in 2017. She conducted her first international mission in Gaza this past Spring.
This interview was conducted on July 2, 2024, upon the evacuation of the European Gaza Hospital. Muhammad discusses the conditions of EGH, the deterioration of women’s health, and children’s safety, the collapse of medical care, and the dire reality of Israel’s annihilation campaign against Palestinians during the Rafah invasion.
This interview has been transcribed and edited for clarity and brevity.
I've worked in various Level I trauma centers. There are different types of training that you receive on mass casualty incidents and disaster relief work, but nothing can prepare you for any war zone, particularly for an active “war zone” like Gaza right now. We spent months gathering medical supplies that were necessary for our field. We were told by FAJR that we were essentially going to a desert — to take everything we would possibly need to do our jobs. We prepared with a great amount of detail, taking tourniquets, needles, IV start kits, vital sign machines — anything you would need in emergency medicine to take basic care of your patients.
We were fortunate enough to go at a time when the Rafah border [was open], and we had no restriction on how many supplies we could take. I took eleven 50 lb suitcases full of emergency medicine supplies. About half a suitcase was my scrubs, protein bars, and some personal items. Every member of our FAJR team had an average of 10 to 15 bags. I've always worked in really high-resource settings where, even in field hospitals, we have the basic equipment we need. That was just not the case in Gaza. We didn't even have things as basic as soap, hand sanitizer, or gloves.
We prepared for several months, gathering every conceivable supply possible. There was also the mental-emotional preparation of going into an active war zone where your safety was not guaranteed — you had to ensure that your family was accounted for and your will was in place as well. We had a Medical Directive in case our bodies were returned to our families in a state between life and death, detailing what we would want done with us and clarifying what would happen in the case of death. FAJR organized with the WHO and the United Nations Office for the Coordination of Humanitarian Affairs (OCHA) to ensure that we had a deconflicted house to stay in while we were there. They made sure our passage was clear every time we left the house to go to the hospital, as it was necessary to clear our travel with COGAT [the Coordinator of Government Activities in the Territories], the liaison entity for the Israeli military.
Once you arrive in Rafah, you are immediately met with this constant, overwhelming sound of drones. It's like a lawn mower next to your head 24 hours a day. The drones are so loud it’s hard to hear your own thoughts. That's followed by continuous airstrikes throughout the day that become worse at night — all around the hospital, all around our safe house, all across Rafah and Khan Younis. We were there from May 1 through May 17, and that was the constant state of being: bombs, drones, and fighter jets. As the ground invasion expanded and the border closed, we also heard tank shelling and gunshots very close to the hospital.
At EGH, there are thousands of displaced families in tents scattered around and inside the hospital. There is a nursing college right across the street from European Hospital where displaced families and displaced staff members are also sheltering. Walking into the hospital is overwhelming to the five senses — specifically when you enter the emergency room. You're first met with the devastating sound of immense suffering — people crying and screaming. Then arrives the smell of human bodies decomposing and various bodily fluids. You're confronted by massive overcrowding, making it difficult to distinguish between patients and their family members. It's not just the patients coming in by themselves: they would be accompanied by their 10 or 20 family members who have nowhere else to go. There are hundreds of patients confined to this 25-bed emergency department serving both pediatric and adult cases. We were seeing hundreds of patients requiring acute attention every day.
We have to reckon with the dire reality of this evacuation order. We are talking about 400 admitted patients with varying degrees of disabilities, unable to walk or leave the hospital. These patients are accompanied by their 10-20 family members who have sheltered alongside them. Some children are the sole survivors of their families who are now being cared for by the community living in tents at the hospital. We met dozens upon dozens of children greeting us as we walked from our dorm to the emergency room every day while we were in Gaza. I've been distraught since I learned about the evacuation order this morning [July 2, date of the interview]. I haven't been able to get in touch with the friends I made there. Many of the nurses and doctors have undoubtedly been forced to leave. I've received voice messages from some of the children, many who have lost their parents, telling me that they're scared and have nowhere to go.
There is no safe place in Gaza. We felt that while we were there, but it has escalated exponentially in the two months since we were there. Where do these people go? These are innocent people who were just seeking treatment, and now they are being displaced for a fifth and sixth time. I can't imagine what Rafah looks like now and how people are going to manage.
The most notable change was the proximity of the bombing and the tank shelling. We were able to see the bombs being indiscriminately dropped in East Rafah and West Rafah from our safe house when we first arrived. Initially, there was an evacuation order for East Rafah to push people west to Al Mawasi, and we were on the border of that evacuation zone at the time, still in the green zone. The first couple of days in May, we were still watching bombs being dropped on the "safe zone" of Western Rafah. The situation escalated every day. We felt increasingly unsafe where we were. The bombs were so close we could smell the cement, the gunpowder, and the chemicals in the air: our walls would be shaking throughout the night. The night the border closed, our team leads made the executive decision to move to the hospital. We got the official evacuation notice the next day.
The Palestinian families living in the neighborhood we stayed at also had to be displaced to Al Mawasi, this barren area on the beach with no shade, no clean water, and no food. It's like pitching a tent on a dune. There was a palpable sense of panic in the air. From that point forward, the types of injuries we saw got progressively worse, as far as acute trauma was concerned. As the end of our mission started to near, originally expected to end on the 13th, we felt the people at EGH panic, because we were a sense of safety for them. They had this idea based on precedent from Al Nasser Medical Complex and Al Shifa hospitals that if there were foreign medical teams, the hospital wouldn't be invaded. Every day when patients would see us with our backpacks, going from one unit to another, they would frantically ask us, "Are you leaving? Is the hospital going to be attacked? Are you leaving because the hospital is getting attacked?"
We would have to reassure them that this is just the end of our mission, and we're not leaving because of any kind of impending attack. We were there for five more days than we had intended to be because the Rafah border was closed, and there was no safe way for us to get out. That coordination was done by our team leaders at FAJR who worked with WHO and the U.S. State Department to eventually get us home.
A typical day was just trying to make sense of the chaos. Our day would start at seven or eight in the morning. We would go down to the ER and immediately start treating whoever we could. Some people would come in through the front triage with a piece of paper that was written with their chief complaint, their name, and their date of birth. We would just start orders because there were so few staff members in the emergency room. There were a handful of local Palestinian nurses and doctors, but there was no set schedule for them. These people have been working without pay for over nine months and they have displaced families of their own that they're trying to care for. Many of them lived in Al Mawasi and had to take a bus to get to EGH, and that transport is not reliable, based on what's happening on the ground. So there were many days where the staff was either bare bones or we were expecting certain nurses to come to work and they wouldn't. We weren't sure of their safety.
Some patients needed to be seen for chronic illnesses and wounds, but then a mass casualty would suddenly come in from a nearby bombing. For example, one day, we were treating patients when we heard a massive explosion go off nearby. We quickly found out that Israel bombed a nearby mosque at Asr, the afternoon prayer time. Within minutes people started to arrive on donkey carts and tractors with massive amounts of patients — think 20 to 30 injured or deceased patients. We had to work through that in what we call ‘black tagging’ in disaster medicine — allocating your resources to the patient that has the highest survival rate. If somebody comes in and they're close to death, then you black tag that patient and move on to the next patient with a higher survivability. We dealt with these kinds of ethical dilemmas on a daily basis because we had such limited resources. All we had were our personal backpacks and fanny packs with basic supplies. Although we took tourniquets, gauze, splinting material, and IVs, we started to run out of those supplies toward the end of our second week. We were lacking critical supplies such as chest tubes or oral endotracheal tubes used to ventilate patients. We lost a lot of people that we could have otherwise saved because we didn't have the supplies to do our jobs properly.
Even then, we tried to draw from the absolutely ingenious, resilient Palestinian nurses and doctors who have created makeshift ways of doing things in the emergency room. As a nurse, my main role was to support the physicians and local staff in whatever way I could. This included starting IVs, giving injections, stabilizing bleeding, administering different types of medications, and helping the physicians with their procedures. Obviously, nurses in a war zone have an increased scope of practice, especially Palestinian nurses. In America, registered nurses don't typically suture wounds, but in Palestine, the nurses are very talented at stitching up wounds, because they don't have enough physicians to go around to do that. They eventually learn how to take on some of the tasks normally done by doctors, because there's such a shortage of staff.
You see injuries such as explosive trauma, gunshot wounds, and sniper wounds. Israeli forces seemed to target limbs, especially in children and young people. Young men would come in with gunshot wounds to their kneecaps, their elbows, or their upper thigh, where we had no choice but to amputate above the joint — making prosthesis difficult. Additionally, prosthetics are often labeled as a “dual-use” item by the IOF and subsequently denied entry to the Gaza strip. We were seeing absolutely horrific shrapnel injuries in which children and young people were coming in covered from head to toe in shrapnel, sometimes lodged in their lungs or hearts. We were seeing explosive injuries that looked like something out of a horror movie — people were coming in with their heads, arms, and legs blown off; children were so disfigured and unrecognizable by third-degree burns that enveloped their whole bodies they could only be identified by scraps of clothing. So many families would bring their loved ones in deceased on arrival from a nearby bombing just for us to confirm that they were indeed deceased.
One of the most notable injuries I can think of was a four-year-old child with an explosive injury from a nearby bombing. He wasn't breathing when he came in, so we started doing CPR and tried to ventilate him. The physicians put an endotracheal tube in him, but once we got his chest X-ray back, we saw that his lungs had exploded. They had shattered. The hyperbaric bombs Israel is using in Gaza are of such magnitude that they shatter the organs of small children. The force of these bombs is so significant that the energy has nowhere to go, so a lot of the time it will travel through the path of least resistance: the face or head. You’ll see a lot of children with skull fractures or shattered lungs, and they will have third-degree burns so severe that their skin is peeling off from head to toe. That was the case for this four-year-old boy. We did CPR on him for quite some time, but ultimately, because his lungs were shattered, there was nothing to ventilate. We were unable to save him. Unfortunately, that was a similar theme in a lot of the children that we saw with explosive injuries. Beyond the burns, the shattering of their organs, and their limbs being blown off, another critical point was that they were covered in shrapnel. There was another similar case where a man came in from an explosive injury, not breathing. His house was bombed. His skull had been fractured from the cement and rubble of his home that had fallen on his head, but beyond that, he had shrapnel embedded in his heart and his lungs. We had to open up his chest in a procedure that's called a thoracotomy. A thoracotomy is like a heroic life-saving measure — a last resort, last ditch effort. The mortality rate for it is very high, but we tried to do whatever we could, including massaging the heart. You're literally holding somebody's heart in your hand, trying to resuscitate them. This man had so much shrapnel embedded in his heart and lungs we could visualize that when the physician would stitch up one hole in his heart, the blood would spurt out from another. Ultimately, he ended up dying as well. People need to understand these details: these are human beings that we were treating for these atrocious injuries.
There is also an immense amount of suffering from chronic conditions beyond the acute trauma. Individuals who are diabetic, have congestive heart failure or have high blood pressure are not getting their insulin or daily medications. Their condition was worsening day by day without these maintenance medications. Another issue was infections. There is no way to clean people's wounds due to the restriction of basic hygiene supplies from the blockade. Patients who have had surgeries from earlier medical missions — their wounds or their amputations are now infected. Many wounds are becoming infested with maggots because Gazans are being forced to live in tents with no access to clean water, soap, or bandages. We saw a lot of septic infections.
As one of the few female nurses, I dealt with a lot of female complaints. Modesty is highly valued in Palestinian culture, and women are treated with a lot of respect. Finding private spaces in the overcrowded hospital to give a woman an injection in the hip, to do a breast exam, or to administer any kind of sensitive exam was a significant challenge. It was extremely difficult to take care of pregnant women or treat any women’s health complaints because there were no private spaces, resources, or specialists. The conditions were also dire from a broader women's health perspective. We were seeing women using tent scraps and pieces of clothing as pads, causing toxic shock syndrome. We haven’t seen this in the Western world in decades because of access to feminine hygiene products. A lot of women came in with urinary tract infections, rashes, and toxic shock syndrome, because they didn’t have access to private bathrooms, or the bathrooms were infested with communicable diseases such as Hepatitis A. Young people were dying from Hepatitis A — a completely treatable, preventable disease. A young, healthy individual should be able to recover from Hepatitis A with no consequences, but because Gaza is restricted from access to the basic treatment or vaccine, young people with Hepatitis A are dying of liver failure. There are a whole host of preventable diseases like that: cholera, dysentery, and other archaic diseases that you no longer see in the West.
Gaza is like a song that you can't get out of your head. This is a theme among any physician, or any nurse that you talk to. They will say that they can't stop thinking about it, and they will go back instantly. That is because Gaza taught us, and continues to teach, resilience. Gaza teaches us the meaning of human dignity and the value of human life. Gaza teaches us empathy and ingenuity. What I gained from Gaza far outweighs anything I did or gave to anyone there. I was constantly in awe of the resilience and gratitude that the doctors, the nurses, and the patients exhibited. The constant reference to their faith, to rebuilding... their homes were getting destroyed, their greenhouses, their livelihood, their universities, and they would remain firm in their faith saying "Alhamdulillah, thank God. It's OK, we're still alive. We're going to rebuild." That type of resilience I have not seen in any other human being. I've worked in the ER for almost 15 years now, and I have witnessed resilience, but never to this level.
To that point, I think it's important to remember that they're still human beings at the end of the day. They also feel helpless, they feel frustrated, and they get angry, because they're human, and they're tired. They're exhausted, but even then they exemplify the best character at all times. They are so generous, so giving. People would share their food with us when they didn't know where their next meal would come from. If they had half a piece of bread, they would tear it into a quarter and give that to you. It was just constant generosity and love that exuded from the people we met. In between the atrocities, there were still smiles, laughter, jokes, and moments of fun that were had. That's the painful part. Now, after we have witnessed this, we are trying to tell individuals’ stories, to get others to understand that the people of Gaza are human beings just like us. They’re the best of us.
Even as a nurse, the type of empathy and dignity maintained was astonishing. The importance of modesty and the respect that they gave women, I took that back to my practice here. Now I'm back at work and I'm trying to mirror the type of dignity and empathy that the nurses in Gaza gave their patients. I thought I was an empathetic nurse before, but the Palestinians taught me so much about the value of human life and how precious that is. I'm trying to honor them by applying that here to my patients now.
