Testimony from Gaza: Dr. Mohammed Shaheen and the health crisis in Gaza

 

Mohammed Shaheen is a mental health doctor at Doctors of the World in Gaza. For 7 months, he has lived in daily anguish: will his children still be alive tomorrow? Where will the next strike fall? Today a refugee in the Middle Area, he nevertheless continues his mission to help the population, and bears witness to the horror he endures every day.

 

HAVE YOU HAD TO FLEE RAFAH SINCE ISRAEL’S MILITARY OPERATIONS IN EARLY MAY?

Not me. But before that, I had to travel twice. During the evacuation of Khan Younes 4 or 5 months ago I had to leave the area where I lived for Rafah. Then in February, when the airstrikes began on eastern Rafah I left for the Middle Area, in Deir el-Balah where I now live. I am with my wife, my three children, my mother, my two younger brothers and my little sister.

 

HOW LONG HAVE YOU WORKED FOR DOCTORS OF THE WORLD?

I have been working for Doctors of the World (DotW) since 2022, it will soon be two years. I am a doctor of general medicine and hold a master’s degree in mental health. I studied the integration of mental health into general healthcare services, which is why I started working with DotW as a mental health doctor. It was in Gaza city, in our office which is now destroyed. We provided psychosocial services and support to institutions across the Gaza Strip.

 

WHAT MEDICAL SERVICES ARE PROVIDED BY DOCTORS OF THE WORLD TODAY IN GAZA?

Since the start of this war, everything has been destroyed. There is no longer a health system in Gaza, not enough medical services, medicines, or even places to give consultations and medicines, no emergency services to help people. DotW began setting  medical points in Rafah at the end of January. Initially we mainly provided emergency primary health care. Then we added sexual and reproductive health services, maternal and child health and psychosocial support, that is to say psychological consultations in individual or group sessions on each medical point. This way we can care for patients who require mental health intervention or refer them elsewhere in Gaza. For this we are in contact with other organizations or clinics of the Ministry of Health. But since May everyone has been fleeing Rafah so we have launched a new medical point in the Middle Area governorate where we provide the same health services. With the evacuation of Rafah we had to adapt to intervene where there are the most people, the most needs, to respond to them as best as possible.

 

HOW DO YOU MANAGE TO FIND MEDICAL EQUIPMENT?

The security situation is dramatic in Gaza. If people suffer, we as an international organization providing health services, psychological support, also suffer from insecurity. We have donations from the WHO, for example, and DotW has also been able to deliver medicine to Gaza. But our stock was stolen from our office in Rafah. We are trying to manage the shortage and replenish our stock with other international organizations. But so far we are managing to meet the needs of the people who come to us.

 

WHAT ARE THE NEEDS OF THESE PEOPLE AND WHAT CAN YOU DO FOR THEM?

My colleagues in the mental health service are mental health workers and psychologists who work directly with beneficiaries, organize support and advice sessions, psychosocial interventions which range from psychoeducation to advanced interventions with people who are stressed, depressed, suffering from psychoses because of their living conditions today. As a mental health doctor, I integrate mental health services with doctors, nurses and psychologists. I help them identify mental health needs during medical examinations, and refer the most critical patients, those who need regular monitoring or medications that we do not have in stock, to appropriate structures. We are also producing training materials for medical personnel to respond to this crisis, not only DotW but also other actors in Gaza, to teach them how to understand mental health and psychosocial support needs. It’s not about treating headaches or body aches without taking mental health into account. We must take charge of it.

 

WHAT CASES DO YOU ENCOUNTER MOST OFTEN?

There are many disorders linked to stress and grief. These are normal reactions that become abnormal in certain situations. Like in Gaza where the violence has lasted too long. It’s not just worth losing loved ones. It’s the pain of losing your children, your home, your job. Everyone in Gaza today is suffering from abnormal pain.

Regarding stress symptoms, they reach extreme thresholds. We are beginning to diagnose multi-traumatic stress disorders. Every day, we encounter cases of significant stress, patients suffering from psychomotor agitation, patients with chronic mental disorders, psychotic and epileptic patients who need treatments that are unavailable due to shortages. We are sometimes forced to change the treatment of these people, to start from scratch with a new molecule even though they had been treated effectively for years and their disease was under control. Suddenly they collapse and you have to find another medication, follow this treatment, monitor the side effects.

And above all there is depression. She is everywhere in Gaza at the moment. More than one in five patients we see have mental disorders. We need to identify these patients and do our best for them. Thanks to our psychologists we can offer psychological consultations, support sessions or start a short therapy, prescribe medication. But I assure you that there is a real shortage of mental health services in Gaza, and of medical services in general. We need a lot of help to get through this situation.

 

HOW MANY PATIENTS DO YOU SEE EACH DAY?

When we started with two medical points in Rafah, we could receive 600 to 700 patients per day.

 

HOW DO YOU MANAGE TO WORK IN THESE CONDITIONS, DESPITE THE INSECURITY THAT ALSO AFFECTS YOU?

My point here is that even our team suffers from multiple traumas, every day. Many of us have lost a loved one, a friend, a family member, we have all lost our homes. And the severe repeated trauma we experience is having to regularly flee from one place to another. Over the past eight months, some of my colleagues have had to travel five or six times. So yes we do our best to help people. We are suffering but we can still help others. We know what they endure because we endure the same thing. We understand their situation and this can help find solutions together sometimes. Daily solutions: how to find food, means of transport, solve problems of overpopulation, hygiene, insects which abound because there is no wastewater treatment. But we need help too. Our team needs help.

 

WHAT IS THE HEALTH SITUATION CURRENTLY IN THE MIDDLE AREA?

When the Israeli army gave the order to evacuate Rafah, people fled to Deir el-Balah. There are only about fifteen kilometers between Rafah and the Middle Area, but the only road considered safe is the one along the sea and it is completely invaded by carts and carts. It takes two hours to make the journey. The Middle Area began to become overcrowded. However, the wastewater treatment system which runs on diesel or fuel oil and cannot pump water towards the sea because of shortages. The streets are full of sewage. Cases of hepatitis A for example were common among our patients in Rafah. We distributed hygiene instructions on how to care for the sick, how to break the chain of infection. I believe we will soon have the same cases in the Middle Area because of overcrowding, living in tents, and promiscuity in the camps.

 

IS THE MIDDLE AREA STILL THE SAFEST PLACE IN GAZA TODAY?

According to the Rafah evacuation order given by the Israeli army, yes it is the safest area. In reality, we still face indiscriminate shelling, especially in eastern Deir el-Balah. And nothing is entering Gaza anymore. No food, no medicine, no tents. The shortages of everything are starting again. The price of the food you buy doubles or triples. Due to the shortage of fuel, for example, bakeries cannot operate and it is impossible to find bread. Everything we still find comes from the foodstuffs that entered Gaza in recent months. At the Deir el-Balah market you will find canned food: white beans, broad beans, canned meat. There is a shortage of fresh food, groceries, vegetables, rice, meat, milk, eggs. I have three children, the oldest is six years old. They haven’t eaten eggs in two months. We are always looking for solutions to feed them. We are trying to stock up on some beans. We keep a kilo of rice. But we expect the worst because there is no solution. So many things have been tried. We are losing hope. It’s like an infectious disease, everyone in Gaza is losing hope. The Middle Area is not suited to such a population influx. There is no drinking water. Even salt water which is used for certain hygiene needs, hand washing, showering is not enough given the number of people in the area. She arrives at homes about once a week to fill the cans. People are fighting for this water. If you can afford to buy it, the thousand liters will cost you 100 shekels, or 25 euros.

 

WHAT DO THE INHABITANTS OF GAZA HOPE FOR TODAY?

So we don’t look too far ahead of us. We are trying to see the days ahead. We pray and hope that the fire will go out, that the deaths will stop, that the destruction of what is left will stop. These days we don’t have much faith in the future. We are all planning to leave Gaza. Maybe not now, maybe tomorrow, later, years from now. Because the lesser destruction caused by previous military escalations ten years ago has not yet been repaired. With what is happening today it is expected that it will take a hundred years to resolve the problems, rebuild people’s lives, repair houses, shelters, sanitation, sewage treatment. It’s going to take a long time. This is why we lose hope.

We just want the bombings to stop, to be able to walk in the street, not to constantly think that we are going to die within five minutes. There is no school for the children. In the camps people try to bring children together to play with them, to offer them psychosocial support. One of our mental health team members is participating. But I don’t want to send my children there. No place is safe. Even evacuation orders that say one area is safe and another is not. But it’s not just a story of tanks or land operations. It’s a matter of air attacks or bombings happening anywhere, anytime. I’m sorry to say this but I would rather die with my children than one of them die far from me. My father was ill when the Israeli army was carrying out its operations in Khan Yunis. I had to take him to Al-Aqsa Hospital in Deir al-Balah. The only doctor who took care of my father, who treated him, who inserted his IV, was me. There was no doctor. No medicine. Nothing. He died in three days. That’s not my story. This is the story of every family in Gaza.