One of the recurring aspects of the Nakba (catastrophe) is the ongoing violence perpetrated against Palestinians. I witnessed this first hand during the 2008-9 Israeli invasion known as Operation Cast Lead.
I had previously worked and travelled to Gaza on a variety of missions for the Norwegian Palestine Committee and for my employer the University Hospital of North Norway. I am a practicing doctor and an anaesthesiologist with extensive experience with land mine injuries in Cambodia, Burma, Afghanistan and in Angola.

The emergency surgical team that was sent to Gaza on 28th December 2008 included Dr Erik Fosse, cardiothoracic surgeon and a close friend of mine and chairman of the Norwegian Aid Committee. Also there was John Evind, a nurse who stayed behind in Al-Arish as a coordinator. We received full support from the Norwegian government, funding of approximately £500,000 and access to all of their diplomatic and logistical support systems in Egypt, where they had negotiated with the Egyptian security people and got us in. We got phone calls from the Minister of Foreign Affairs and the Prime Minister expressing that the government and people were behind us in this mission. This represents a real turning point for solidarity work in Norway. 15-20 years ago, we were chased off the streets when we had demonstrations for Palestine. Patience is important in this work.West Beirut 1982 – Khalil the Brave

My first professional experience with the Palestinians was in Beirut in 1981. When the Israelis invaded Lebanon in 1982 we were called upon to send surgical teams and I was in West Beirut in 1982, during that horrific summer, literally wading in blood. I thought it would be the worst experience of my life but I am sorry to say that Gaza 2009 surpassed Beirut 1982.

I met many Palestinians in Lebanon. One was Khalil. Khalil changed my views on many things in medicine and politics. The strategy of the Israeli army was to go all the way up to West Beirut. They cut the power, water, food and medical supplies. We were actually smuggled in and we worked in a makeshift field hospital. Israel bombed residential areas, hospitals, everything.

One day a Palestinian boy named Khalil and his mother went out of their little house in the Shatila refugee camp (this was before the massacre) to watch the F16 jet fighters from Israel coming in over West Beirut as they did every lunch time to drop their deadly cargo of bombs. A bomb landed close to Khalil and his mother. His mother was killed right next to him and his arm was almost ripped off. He was carried into the local hospital and a team of Norwegian and Palestinian surgeons and nurses amputated his arm. The next morning he was sitting on his bed in the hospital and an American photographer took a picture of Khalil. He was, as is to be expected, shocked. He had lost his arm, he had lost his mother, their home was destroyed and all his belongings were in a plastic bag at the end of the bed. The bed sheets were dirty and bloody because of the lack of water. He was completely without emotion, shocked and paralysed.

We had an urge to care for him, we felt pity but he didn’t need pity. Actually Khalil, like others in extreme situations, has another side. I did not meet Khalil at the time the photograph was taken; I met him a week later, after he had been transferred to the Lahut hospital, where I worked because the Israelis had bombed the other hospital. That is when I saw the other side of Khalil; mastering, coping, the strong Khalil in control of his own destiny. He insisted on dressing his own amputation stump twice daily, he took off the bandages, removed dead tissue, as we had taught him how to do it and he put on new bandages. Not only did he care for himself in a very impressive way, he was also a ray of light in the hospital. He went from bed to bed straightening the sheets, fetching water when we had it, singing songs and every time Abu Umar came to do rounds at the hospital, he would hold his hand. He cared a lot. He also insisted that Palestine one day would be free.

For me, Khalil was an experience that taught me to always look for strength in suffering, not only to pity. It is extremely important when undertaking solidarity work to facilitate the strength of people, not drown them with pity and paralysing feelings. We all have a chance to stand up and to fight on. I hope to run in to Khalil again one day.Prison‘Gaza is a prison’, said John Ging, the brave Irish leader of the United Nations mission in Gaza in 2009 after the attack, ‘1.5 million Palestinians are imprisoned in Gaza’ he told the world.

I have travelled in and out of Gaza during the past 15 years. It is almost impossible to reach via Israel. The Rafah border to Egypt is a 14 kilometres long barrier with fences, barbed wire and steel that goes deep underground blocking supply tunnels. 80 per cent of the population is now below the UN-defined poverty line, but they maintain their dignity.  

I went back last year, nine months after the invasion; I travelled extensively and met many of the survivors of the attack. Because of the continuous siege, nothing has been rebuilt and poverty is widespread. Almost the whole private sector remains inactive and people are unemployed. 80 per cent of the population depends on food aid from the UN. And almost all of the 4.5 billion dollars that was pledged remains in the bank because of the continuing Israeli siege. There is no building material, no construction material, nothing is allowed in.

The conditions under which people live are the most important factors for determining health. I took pictures in Gaza of part of a refugee camp that had not been bombed, of the normal habitat in Gaza. Healthcare is not that important for health; much more important are safe water, safe food, human security, housing, work and education. All of the six items on this list are lacking for the 1.5 million people in Gaza and have been further aggravated through the siege and of course Operation Cast Lead. And as a doctor I think of prevention and not only cure. In such a situation medicine becomes very political. In Abed Rabu in the North Eastern part of Gaza, my translator, a young journalist, said that “the only thing that I want is to live in peace, to have family and children, I have no political ambitions, just give me peace”.

To quote from the Lancet medical journal special report on Gaza in March 2009: “All qualitative measures of health, suffering, fear, humiliation and exposure to violence – are increasing” .The Ongoing Nakba: December 2008-January 2009

I made some of my best friends, people I consider to be brothers, in Gaza: Dr.Issam Abu Ashra, a very gifted surgeon, a father of three living in Al Montar. Also Dr.Raed Al-Arini. In March 2008, I was teaching at Al-Azhar University where I was a visiting professor at the time. In the Shifa hospital all the windows were shattered and blown out by a bombing close to the hospital. It is important to understand how the weapons the Israelis used affect the human body. I describe the medical work, never seen on international television, not because the footage is unavailable but because the footage is so disturbing that people all over the world would stand up and say ‘enough is enough’. That is why Western audiences are shielded from these images while as a doctor, I have access to them. Dr Erik and I decided that it is our duty to be the voices of those that cannot speak up from inside Gaza and to tell the stories of all those who were carrying the burden and suffering of the attack on Gaza in 2008 and 2009.

The first attack came at noon on the 27th of December as we were celebrating Christmas across Europe. The Israelis had predefined the targets through a two year preparation period as disclosed by the Israeli Generals who meet regularly in the NATO council where they sit as members of the so-called Mediterranean club. Two years of preparation in which every single target was mapped and decided with coordinates. This was not indiscriminate bombing; first of all the police stations were hit, part of the civilian community under international law. Why take out the police force? Because in a disaster you always need the police to lead the response.

They dropped 100 bombs in four minutes, killed more than 250 and the 600 wounded were rushed to the hospitals close by and to the Shifa hospital. The bombing of Gaza city was the bombing of a city of 800,000 people.

John Ging described ‘death and destruction everywhere’. Everyone he met in the UN shelters had a traumatic story to tell. It was horrifying. Those who carried the burden were the civilians, the women, the children and the elderly.

Israel bombed children in their classrooms, in a UN shelter despite the coordinates being given to the Israeli officers in clear violation of International Law. The face of the child expresses exactly what it means to survive physically unharmed but with vivid memories of the fearful sounds, the sights and the smell of death and destruction.

Just one example of what they did is at the Beit Lahia UN School which had been declared a shelter. 1800 civilians took shelter there. Not only did they bomb it, but they bombed it with white phosphorus which is illegal when used against civilian targets. Two boys were killed, fourteen injured. Among the fourteen was the mother of the two boys, we had to amputate both her legs at Shifa hospital.

Truth is the first victim of war. The Israeli spokesperson said that the Israeli military forces were “protecting the civilians”. A lie.In addition to the physical injuries, the whole paediatric population of Gaza, were lacking blood before the attack started, were lacking nutrition and were cold because of the lack of energy available to heat their homes. Hypothermia, anaemia and malnutrition would go from bad to worse because if you have a trauma with these factors in the background your wounds heal much slower as bleeding intensifies. Why did they cut the energy to Gaza? To put out all lights and to make it ice cold.

The Lancet is one of my favourite medical journals. In an issue in 2006 they stated that “Health is now the most important foreign policy issue of our time” . I wholeheartedly subscribe to that and I will offer two examples. When the Israeli ground forces invaded Gaza, it was the result of a foreign policy decision by the Israeli government supported by the US government. That was politics, foreign policy.

Medicine is politics. It is about security, it’s about distribution of wealth and it’s about access to water, food, safety, education and work. Every single bomb that hit Gaza during those 22 days was the result of foreign policy decisions and we tried, together with the brave medical staff, the paramedics and the volunteers to limit the effects of these foreign policy decisions. We could not be doctors in Gaza without being political doctors. That would have been a betrayal of all our patients and of the population in Gaza.

The 23 day attack was a man-made disaster. It was no earthquake, no flooding, no random hunger crisis for a population struck by drought. It was planned; it was a 100 per cent preventable if the Israelis and Americans favoured a political resolution. And it went on until they had finished. Nobody from the powerful nations in the West, be it the EU, Russia or the US stopped the Israelis before they had finished. 85-90 per cent of the victims, the dead and the injured, were civilians.

Can we really understand what happened? As a scientist, I speak the truth and try to comprehend the world through numbers and statistics. I know it is hard to understand what happened in Gaza both at the time and what is happening now, just through the numbers. That is why I zoom in on the individual story, the narrative of a family; an injury, a death. Individual casesOne of these is about Jumana Samouni, nine months old. We amputated almost the whole of her left hand leaving just two fingers remaining. Why did we have to amputate? Jumana came in alone from what appeared to be an attack on a civilian house with a lot of people living in it. We thought it was a rumour but gradually we realised that the Israeli ground forces had rounded up about one hundred members of the Samouni family in Zeitoun, a poor neighbourhood in the south of Gaza City. They had to stay in an industrial building overnight without food or water, terrified. The next morning it was bombed by Israeli forces. Thirty were killed, forty were injured, among them Jumana. Her father was killed next to her. Her mother, 18 year old Mysa, managed to save Jumana’s life by covering her body with her own, but she couldn’t follow her little child to the hospital. Jumana survived, her mother came to the hospital and then we got the whole story. I met Jumana again in August 2009, nine months after the attack. I think that these stories of these children give you a better impression of what the costs of these attacks really are.

I met Jumana in Zeitoun, aged one and a half years old. She was with her mother, a widow aged 18. Mysa lost her husband, she had fairly recently married. She had lost her grandparents, her parents in-law and she remains with her little daughter. She asked me “Dr Mads, can you please take a picture of Jumana’s hand?” I said yes I can but asked why. She clearly spread out the two remaining fingers of Jumana’s hand. As I took the picture, I thought that this is the true picture of the cost of this attack. Mysa says that “I want you take the picture home and I want you to ask your good colleagues if they can do some surgery on her hand to replace her lost three fingers”. I undertook to do that and I talked to my plastic surgeon colleagues who said they may be able to attach a couple of toes to her hand but she would need to come to Norway. And there the story stops without relief for this child because Mysa cannot get out from Gaza. This is the true, seemingly endless cost for the people of Palestine of this brutal policy.

Amal Atteia, Jumana’s cousin, came into the hospital three days after the attack on the building because the Israeli forces did not allow any ambulances or any representatives of the international community to enter the building despite the fact that everybody knew that there were bodies, people wounded and survivors in the building. On the fourth day they were allowed in but they had to walk the last kilometre before they got in to the house to recover the dead and the wounded. Among them was Amal Atteia who was found by her brother. I was called to the ward in the middle of the night and told “Dr Mads we have a new casualty from the Samouni massacre”. I saw this little girl Amal and thought that she was an old lady. She was actually nine years old, freezing cold, dehydrated, having stayed almost four days and nights among the rubble of the bombed house listening to the screams of the wounded relatives and smelling the decay of her dead relatives. She was recovered by her brother who bravely took her to the hospital. She had no life threatening injuries and survived, but to what life?

I met her again nine months later. She was standing brave and very polite outside her new habitat, tents in Zeitoun because the family has no building material to rebuild with. They had collected some breeze blocks, maybe one day they will get some cement. Her cousin Mahmood had an open fracture in two places which we operated on. Amal Atteia, Jumana, Mahmood and the other children in the Samouni family will, for the rest of their lives, remember the bombing and these wounds will not heal until they see some form of justice, the perpetrators being taken to court so that they can see that there is some kind of justice in the world.

They have only one remaining house in the family’s Zeitoun neighbourhood and within it they have made a collage of pictures of the 30 killed family members. I met some of the surviving men from the family as I did in the Shifa hospital in January.

What is the future of Mysa and Jumana? I do not know, but I do know that it is part of all of our responsibilities because what we do or not do in the West will be the force determining the preconditions of their lives.

“Palestinians are people who were never safe even before the 1967 Israeli occupation” . A quotation again from The Lancet, from a special issue on health in the Occupied Palestinian Territories.

I took a picture of two schoolgirls coming back from a makeshift school because the school has not been rebuilt, in AbbedRabu in North Eastern Gaza, nine months after the onslaught. Nothing had been rebuilt.Sources and LanguageThe most important source of truth is the Palestinian narrative, the stories they tell. That is why my colleagues and I wrote a book ; to share the narrative of the Palestinian people in Gaza. They know the realities, they can tell the stories.

The Goldstone Report is also a vital source, an accurate autopsy of the whole attack. Almost 600 pages, 1200 references; the closest you can get to an historical summary. Of course the Israeli side is not very well represented because the Goldstone Commission was denied access to Israel so had to rely on open sources. Other useful reports on the Gaza invasion have been published by The Arab League Independent Fact Finding Commission , Amnesty International  and B’Tselem .

The Lancet Palestine special contains a large number of highly scientific reports on the connection between health and occupation in the Palestinian Territories, the first time to my knowledge that this has being scientifically investigated. The conclusion reached is that there will be no solution to the health question of the Palestinian people in Syria, Jordan Lebanon, West Bank and Gaza until there is a solution to the question of the occupation of Palestine.  

As well as utilising expert sources, it is important to recalibrate our language. It is useful to note the language used in the Lancet: “the structural and political conditions that they endure in the Occupied Palestinian Territory…”  there is no reference to ‘conflict’; ‘occupation’ is the key. We have to carefully consider the words we use and maintain accuracy.

My book does not talk about settlements, but about colonies because they are colonies, not settlements built on a void of land. We do not discuss settlers; we talk about occupants as that is what they are. We should talk about Israeli attacks, not defence and we should talk about Palestinian defence not attacks. These words are important; we must rinse our language and calibrate our words because words shape our reality.

I wrote a paper in the Lancet while in Shifa and it was published on the 17th January 2009. It was immediately attacked by the Israeli government who called my colleagues and me liars, telling the Lancet editors that they should not have published it. Medicine is politics; the Israelis make it so when an extremely softly spoken account of conditions in the Shifa hospital was attacked. The SiegeGaza is small and more densely populated than both Hong Kong and Singapore. In June 2006 the siege began and has since tightened its grip. From Satellite photographs of the area, it can be noted how lush and green the occupied land around Gaza is in contrast to the besieged land of Gaza which looks like a desert because everything is utilised in Gaza to provide some sort of self-supply of vegetables, meat and so on.

The Shifa hospital is four blocks away from the Mediterranean shore in central Gaza City. It is a good hospital; we have been working there for many years. It has almost 600 beds, a thousand employees; it has 400 doctors of all operation specialities including open heart surgery. It could have been a university standard hospital but it was completely drained by the siege. I was in Gaza in October 2008, just weeks before the attack. I had long meeting with the leaders in Shifa and they said that they could not go on much longer, as they lacked everything: spare parts for the lifts, trolleys, drugs, equipment. They also said “we don’t have electricity, how can we continue doing healthcare?” On top of that came the attack and the patient flow. The siege has taken a great toll.

It is well know that Gaza has a young population, the average age is 17.6 years, 60 per cent of the inhabitants are under 18. This is the largest and youngest prison population on earth today, 800,000 children who have done nothing wrong but were born Palestinians in Gaza. This is a very vulnerable population. Children cannot identify sounds and understand as much adults when it comes to being attacked, running and sheltering yourself. Being Palestinians in Gaza they have to adjust to such painful experiences. Chronic malnutritionReports show that the population of children in Gaza are malnourished . Within the Lancet special issue on Palestine there are figures based on 1996-2006 about stunting. Stunting means that a child’s height is lower than it should be at their age because they are not growing appropriately. This is caused by lack of protein through malnutrition. The stunting of children in Gaza has increased quite dramatically over the last ten years. Malnutrition and stunting also affects cognitive development. This is a man-made starvation, carefully managed to avoid the blame of the international community, starving them day by day, as the Wikileaks documents  have shown.

After the bombing came more starvation. As noted in the Goldstone report, as a large proportion of Gaza’s factories were targeted and destroyed or damaged, poverty, unemployment and food insecurity increased dramatically. The Siege 2011A report published by 22 International NGOs  in November 2010 stated that the import of construction materials is only at 11 per cent of pre-2007 levels with Israel approving import of only 7 per cent of what is necessary to meet the UN’s rebuilding plans. That refers only the UN rebuilding plans let alone the need to rebuild the entire private sector, industry, housing and the rest of Gaza’s infrastructure. The same report includes a table showing what the Israelis are claiming the level of imports are and what the true level is. As John Ging said when he was commenting on this report, because there was an international pressure on Israel to ease the siege after the attack on the flotilla an impression of an easing was presented, although nothing has changed in reality. The only thing that increased was tokenistic international pressure on Israel and Egypt.

As I entered into Gaza City on New Year’s Eve 2009, I saw long lines, queues of people and I asked my driver, a paramedic, what people were queuing for. His response was “Dr Mads, you don’t know? This is the bread line of Gaza, we have four remaining bakeries and people get up at 6 O’clock in the morning, 800 people standing in line to get some bread, most of them don’t get any bread”. This is happening in Europe’s backyard.Prior to the attack on the 27th December Gaza was in a dire condition due to the siege. There was outright starvation, anaemia and widespread malnutrition among children. Hunger is used as a weapon of mass destruction. It is illegal but it is used systematically by Israel to deprive the Palestinian population of their energy to resist. The AttackIn other conflicts during war time, during the first one or two days there are a high number of civilian casualties and then people fly away to the neighbouring province, countries, up in the mountains, or out to the jungle. Not so in Gaza where there is nowhere to fly, nowhere to go. Attacking Gaza is like fishing with dynamite in a pond. It’s the most cowardly way of fighting a war that I can think of. To bomb people who cannot escape, where there are no bomb rooms and no shelters underground because the Palestinians are not allowed to dig. There is no early warning system, no functioning civil defence, no protection of the civilians. And they bombed them.The Rescue The rescue was extremely dangerous; I re-lived what I had seen in Beirut 1982. First the bombing, then all the heroic people who tried to recover their fellow men and women, and then the jet fighters came back again and bombed the rescue teams, just like Beirut in ‘82.

People did not wait for ambulances, in Gaza it is a tradition that you put the wounded in a taxi or you simply carry them in your hands to the hospital. And they came pouring into all the hospitals, in masses. The hospitals were over flowing.

Every time there was a bombing we would hear the sirens, we would hear the horns from the cars and people came rushing in like a scene from Dante’s inferno. For the first two days it was extremely chaotic, then they regained control and when we arrived on New Year’s Eve they had gained more control. Not only did Israel bomb police stations, houses and government buildings but they bombed ambulances, hospitals and medical staff that were clearly marked for international protection.

They bombed almost 60 mosques. I asked one of my good colleagues in Shifa what would happen if the Palestinians had bombed 60 synagogues. He said “Dr Mads, don’t be so stupid, you know what would happen” I also asked what would happen if they killed 400 Israeli children. “Another stupid question, you know what would have happened; we would have been nuked out”.

Did the world react to the fact that Israelis systematically bombed mosques? Not at all. I asked my colleague why would you not bomb a synagogue and he said “it is very simple, it’s the house of God, Palestinians will not bomb the house of God”. There were many educational buildings bombed. This is strictly prohibited according to the Geneva Convention, Article 25. Was anybody taken to court for that? Not a single one.

They bombed 280 schools; none of them have been rebuilt. I went to these schools in August 2009 and the classrooms were destroyed. The Palestinians are masters of improvisation so they had some makeshift schools; they doubled the numbers of students in each class and they ran three shifts of school; morning, mid-day and afternoon shifts. The educational infrastructure of Gaza has still not been rebuilt.

They bombed residential areas, they bombed Jabalia, all the other camps, there was enormous destruction.After 23 days of bombing and the ground invasion, more than 1400 were killed and more than 5300 injured. These are the consistent numbers from all of the reports.

There are four elements to Israel’s tactics. Number one: a long-term siege, collective punishment and demoralisation of the population. Number two: as they say themselves, a completely disproportionate military attack. It is called the Dahiya doctrine, i.e. bomb the hell out of them. Anywhere area rocket is sent from, bomb it. Be it a village, a refugee camp, anything. They developed that doctrine during the 2006 attack on Lebanon.Number three: a news blockade, no journalists are let in. There was nobody there from the western media.Number four: humanitarian blockade.

13 Israelis were killed and 1400 Palestinians, the ratio is 1:100. It is not an eye for an eye. It’s a life for a hundred lives. Of the 13 killed Israelis, ten were soldiers, three were civilians and none were children. Of the ten soldiers killed, five were killed by friendly fire. Of the 5300 injured Palestinians every second was a woman or a child below 18 years old. These are the numbers and the facts.  Some Israeli WeaponsDuring Operation Cast Lead Israel used drones (unmanned aerial vehicles), Dense Inert Metal Explosives (DIME), Flechettes and phosphorus bombs. Drones are new unmanned weapons. These are called ‘fire and forget’ weapons meaning that the officers, the government and the Prime Minister do not have to care or be concerned about dead soldiers coming home in body bags. This is the modern warfare, this is what we have to expect. But of course the hand shooting a rocket at a rooftop in Gaza via remote control is just as morally, politically and legally responsible as the one shooting directly at the child.

One of the many victims of the drone strikes, probably a DIME weapon, was a fourteen year old boy whose right leg was ripped off at the level of the thigh, his left foot was almost cut off and he had large bruises but no shrapnel. The DIME charge is in a composite box and it does not produce shrapnel. With a grenade it will ignite and will explode the metal casting producing a swarm of shrapnel that can travel and injure people 800 metres away. Not so with a DIME bomb, which has no shrapnel and no penetration of the chest or abdomen. The child died in our hands and we could not resuscitate him. What was it like?Being there in Gaza during the invasion is something that is difficult to convey. We stayed in the hospital, day and night, living there for those two weeks. We shared food and living conditions with our brothers and sisters in Shifa. But there was an overwhelming sound carpet all the time, 24 hours you heard the drones, you heard the bombs, you heard the tanks and you heard the very heavy 122 artillery from the tanks. And all the time there were waves of injured coming in, nine out of ten were civilians. I saw a handful of soldiers, fighters. And I know what a Palestinian fighter looks like.

I took a picture of a small family in the entrance of the hospital; one of the most painful pictures I took. It’s at the entrance of the Shifa hospital, where the windows are covered in paper, they were all shattered because they bombed the Shifa mosque on day two and all the window panes in the surgical building were shattered, killing a hospital worker. The two children in the picture came in with their Dad, their lifeline. They were not injured enough to be admitted, we examined them and sent them into the dark cold January night, with the bombing on-going. Darkness was everywhere because the electricity had been cut. The two girls were scared, shivering due to the cold, hypothermic, anaemic and malnourished because of the siege. They are two of the 80 per cent below the poverty line.

Words cannot satisfactorily describe what the sounds these children were exposed to were like. The hospital was filled with relatives sitting and lying waiting for news outside the operating room, outside the ICU and in the main entrance. And all the time we heard the drones one, two, three and four at a time and we heard the artillery coming from the naval ships.

The Israelis maintain that this was a very successful operation. Their spokesperson said on the second and third days that 90 per cent of the bombs hit the intended target. The same was repeated by the President at the end of Operation Cast Lead. So 90 per cent of those 1400 killed were meant to be killed. They insisted that they hit want they wanted to hit, that all of their rockets have video cameras, they see all that they aim at and they knew what they were targeting. 50 per cent of the wounded were children and women.Shifa HospitalThe surgical block entrance of the hospital is probably the most filmed emergency entrance in the world. Our link to the outside world, produced through the Palestinian television company with a van stationed outside the entrance. We gave all of our interviews around the entrance, we never left a patient to give an interview but we gave between 15 and 20 interviews per day.

The siege had led to a severe lack of everything that you need to run a hospital; in particular the advanced intensive care work was hard to do as was some of the more advanced surgical work. The hospital was ice cold and was running on two very old generators that frequently stopped. So quite often the light would go out in the operating room and as the patients were not allowed to have torches or headlights, they were using their mobile phones to see that they were still in the right part of the operating field.

The ambulance workers did a heroic job to get the injured to the hospital. Of them, 16 were killed on duty. Among them was Arafat, father of four children, killed by a flechette grenade shot at their ambulance, his partner was killed instantaneously and Arafat bled to death. Because the flechette is actually a nail bomb in a grenade, he was penetrated in the chest and abdomen and he bled to death. I had trained him among the other paramedics and he was one of the 16 killed. 15 ambulances were bombed and almost 50 health facilities were targeted.

It is instructive to study the pattern and number of those killed and injured per day, starting on the 27th of December and ending on the 20th January. 230 were killed on the first day; the number of those injured was 500-600 per day. Not even a well-functioning hospital system in Britain could accommodate this large of number of those injured, let alone a hospital without water, electricity, supplies and security. It was nothing but historic heroism that enabled the Palestinians managed to take care of all the wounded.

We saw many amputations, around 100, many limbs that were already partially amputated by the Israeli weapons. Added to that were the flow of head traumas and many multiple traumas.

Every time there was an intake it was very intense in the emergency area on the first floor and then those that needed surgery were taken up to the surgical department. There were six operating rooms but when we had 15 people that needed immediate surgery we had to find a way to increase capacity. So the Palestinians would improvise and operate two patients in each operating room, sharing the anaesthetists. Working on a head injury and an abdominal injury in the same room and then suddenly there would be twelve operating rooms instead of six, we would also operate in the hallway; and this went on day after day.

The real heroes were the medical staff, the volunteers, the men, the women who worked in all the hospitals and the pre-hospital systems in Gaza. Their efforts to support the terrorised population and save lives is demanding of the deepest respect. The PatientsMost of the patients were young civilians, they would be unprotected, insecure, often hungry and anaemic. Most of them had some family members with them, most also had lost family members. But the Palestinian family system is quite extensive and they take good care of each other. 431 children were killed, 1872 injured; 2300 children injured and killed. These numbers came out every day, at 4 o’clock every day the Ministry of Health would issue the daily statistics and the numbers of children killed increased day by day. So the international community, the UN, the US, the diplomatic corps knew about it all.The lucky ones, those who could walk and talk were filtered out of the hospital; we could not even admit them. But many of those injured needed some form of surgery. My friend Dr Khalil Abu Foul said “we don’t have 5400 injured, we have 1.5 million injured, everyone is suffering”.

The unlucky were those we could not operate on, could not resuscitate. Then there were the needy, those that needed immediate surgery to survive. To explain just how much work that takes, I use an example of a man injured from the same explosion as the young 14 year old boy. First it is necessary to find out what kind of injury it is using my anaesthesia equipment to put in an IV cannula. He was breathing by himself; I amputated his right leg because it was falling off. We thought it was a DIME bomb. We then we looked for other injuries and stopped the bleeding. He does not need immediate surgery; he just needs the bleeding to be stopped. The bleeding is stopped with a packing and a compressive bandage and his amputated body part was buried in accordance with Islamic tradition by his relatives. Then later the same afternoon the man was taken to the operating room when there was capacity on the operating table for his anaesthesia. It was necessary to unpack the bandage, remove all of the dead tissue, extremely meticulous work. If it was not done properly he would have become infected with septicaemia and died. This cleaning of the wound had to be done at least once a day. Every time you save somebody, you accumulate even more work.

The Palestinians organised, they were the masters and we just found our place as solidarity workers. We don’t support Hamas, we don’t support Fatah or the authorities in the West Bank. We support the Palestinian people and their right to resist occupation. And we support the Palestinian people’s right to democratically choose their own leaders just as we like to choose our own leaders.The woundedTwo more stories to give you the narrative of the Palestinian people under attack in Gaza. One story is about one of the 5400 injured, waiting in line outside the operating room for surgery, two children lying on a stretcher, both severely injured, traumatic amputations in need of immediate surgery. By the end of the stretcher there is a man in a green operating gown, he is desperately using his mobile phone. It turns out this man is Dr Al Arini; the injured on the stretcher are his two children. The Israelis bombed his house while he was on-call, his wife is missing and he is trying to find out if his wife is alive or dead. The two children get surgery and survive, the wife comes to the hospital in the afternoon and the next morning Dr Al Arini is back on call.

To give you a small example of the extreme burden on all the health staff in this system and the enormous courage and discipline they showed, three days later I met Dr Al Arini in the middle of the night and he asked me about the man on the operating table and whether he will survive. I tell him he will survive, but we have to amputate his left leg. ‘Why do you ask?’ I enquire. He replies that the man is his cousin, his uncle’s house had just been bombed, his uncle killed. The onslaught was merciless and unrelenting.

The second story is revealing and representative of the many deaths of children. Ahmed was 12 years old and from Al Montar, one of the toughest areas of Gaza, known for its resistance. He came in after a brutal rocket attack and I declared that we could not save him. But he was taken to the operating room because we had some capacity and somebody whispered in my ear that it was the nephew of one the doctors, a good friend of mine and he was operating in the room next door. He had stopped breathing, so we incubated him and started resuscitation. My friend stopped in the doorway and just nodded, stating that it was indeed his nephew. I stopped the chest compressions, went to put my arms around him and started to cry and said I’m sorry. He took my shoulders, and shook my head up and said “Mads, we just have to carry on, this is our life”. He went over to his nephew, stroked his forehead and went back to do surgery. Ahmed lived until he was 12. The leader of the attack, President Shimon Peres said at the end of the operation: “Implementation of the current operation has gone 90% according to the plan”. NEED QUOTE JERUSALEM POST Ahmed’s life was taken according to the plan.Peres continued that Israel’s aim “was to provide a strong blow to the people of Gaza so that they would lose their appetite for shooting at Israel. That’s all.” He failed to acknowledge that such collective punishment is illegal under international law.What can we do?

When you see a 17 year old boy after surgery, both legs and one arm amputated, you feel desperate, helpless and you don’t know what to do. But we have to do something and what we can do is provide solidarity.

I took some photos at the Gaza Municipality Artificial Limb Shop, which is a highly professional prosthesis workshop in Gaza City, run by the Palestinians. I met Ahmad Nabhan a double amputee from Operation Cast Lead, he was being fitted with his new Palestinian made prosthesis in Gaza City, his new legs. His house had been bombed, he has seven children, he lost both legs but wants to carry on.

The prosthesis are made in a workshop headed by Hazim Shawwa. It was to close due to the siege but thanks to a woman in Norway it was saved. A woman in Northern Norway who was brave enough to start breaking the siege on Gaza started a solidarity concert in 2006 after the Operation Summer Rains attack, collecting almost 5 million Norwegian Krones and the artificial limb workshop in Gaza did not have to close. It is still open due to her efforts; it is an example of what Margaret Mead said, “Never doubt that a small group of thoughtful, committed citizens can change the world. Indeed it is the only thing that ever has”. Hazim in his workshop told me “your money is not the most important thing, your solidarity is”.

I also took a cheque to Gaza in August 2009 for 2 million Norwegian Krones. We gave it to Jameila Al-Habash. She lost both her legs, her sister was killed on the roof by a drone attack and her cousin Mahmood lost a leg. She received the cheque on behalf of all the young amputees in Gaza. She is striving to get back to walking on the new prosthetics that have been made for her.

Solidarity boosts morale in Gaza and it can be very effective. The Boycott Divestment and Sanctions movement secured a great victory in Denmark, where the government was forced to divest from Elbitt Systems. This can be replicated around the world.

When I returned home from Gaza I was given a pair of mittens, knitted by a woman who told me that she cannot go to Gaza but can knit; while I can go to Gaza but cannot knit. Her contribution was to keep my hands warm. It has since become fashionable in Norway to make ‘Gaza Mittens’ in Palestinian colours. It is a huge campaign and the all profits go to the artificial limb workshop. There are hundreds and thousands of mittens being knitted by women who won’t go to demonstrations or wear the keffiyeh, but they do like to knit.

To conclude this very personal account I will mention my strongest memories from Gaza in 2009. Firstly, the Palestinian health workers, who never gave in, never left their posts, always treated their colleagues. I remember all the teamwork, the staff’s enormous capacity to improvise and to find solutions. I remember the nurses working day and night in the ICU as lights were going out and respirators failing, but always on their post.

I remember all the volunteers and medical students, doing their very best. I will never forget the heroic ambulance workers, who sacrificed their lives, evacuating people from Shifa to other hospitals to increase capacity, dangerous and often deadly work.

I remember all the warm teamwork, all the companionship, all the laughter, all the devilish humour that we used to survive and not to give up. I learnt from these extremely brave people.

I remember all of the waiting families, their despair and their waiting for news about their loved ones who might have been dying, who might survive.I remember all the children, their glances, their silence. I remember all the meaningless losses, all the young people losing their arms, their legs, their fingers, their eyes and their lives. Totally meaningless.

I remember all the friendship, I remember all the millions of cups of garabiya and all the cigarettes. I don’t smoke but in Gaza I smoked all the time. It really is Marlborough country; we smoke, we drink coffee and we survive on the friendship and the companionship.

The dignity of the Palestinians stands out. The Palestinians in Gaza carry our dignity on their shoulders. They never let themselves be tempted to behave like the animals that they are treated like. On the contrary, they are polite, show hospitality, they are clean, they share their food. One night in the hospital at 4 am, I was extremely exhausted and I sat down on the brink of tears and a young student nurse put his arm around me, shook my shoulders and said “don’t look sad Dr Mads, it will be ok, it will be ok”. Two days later his sister was killed and he came back to work.

Remember Occupied Palestine is not only war, blood, suffering and death. It is also daily life, smiles and hope. And people who want to live in peace with their neighbours. Nelson Mandela has said, “Our freedom is incomplete without the freedom of the Palestinians”.

Gaza City is extremely beautiful, a real world heritage site; it should be destination for tourism not for rockets. It is dignified, it is strong but it is exhausted. They need us. Gaza lives, the shababs, the women, the children, the young people in Gaza will not give up with or without our support. But they deserve our solidarity and I think that we should all work even harder than we do. Gaza will never give up and one day the Nakba will end and there will be a free Palestine.  Dr Mads Gilbert is a practicing doctor and anaesthesiologist with extensive experience working with land mine injuries in Cambodia, Burma, Afghanistan and Angola. He worked in Gaza during Israel’s 2008-9 invasion and is the co-author of ‘Eyes in Gaza’.