Australian doctors on the front line of Gaza’s crumbling health system have recounted harrowing scenes as the Palestinian enclave remains under immense strain amid a ceasefire in limbo.
They are among few Australians to have entered Gaza amid with access largely restricted as Israel controls Gaza's airspace, territorial waters, and two of its three border crossing points, with the third controlled by Egypt. International journalists are also beyond escorted trips arranged by Israel's military.
Neurosurgeon recently returned home to Melbourne after spending two weeks volunteering in Gaza hospitals, many of which are overwhelmed, understaffed, and lacking in essential equipment and resources.
He said while he was prepared for the situation, seeing the war-torn landscape and struggling community with his own eyes was confronting.
"You see it so much on the TV and social media, but it's very different when you see it in person, it really is quite confronting," he said.
"It's almost surreal seeing that level of destruction; I don't think you're ever prepared for it until you see it."
During his time in Gaza, Awad performed most of his operations out of the European Gaza Hospital. He also visited the other hospitals for consultations with patients, including Nassar Hospital and al-Aqsa Hospital.
Awad said he mostly treated patients with brain tumours or spinal conditions that had been left untreated due to the war, as well as people who had experienced gunshots to the head or spine, and injuries from shrapnel.
He described the level of need as "intense", with hospitals full of inpatients and outpatients, as well as many others "hanging around the hospitals with nowhere else to go".
"You feel like you'll never get through everybody in the time you're there," Awad said.
"I was there for two weeks and I did absolutely everything I could to get through most people. There were two or three times where I'd operate through late nights just to try and get through the cases."
Palestinians walk amid the rubble of destroyed homes and buildings in Jabaliya, northern Gaza Strip on Friday. Source: AAP, AP / Jehad Alshrafi
'Shocking' scenes and a 'bittersweet' goodbye
Dr Chris Holden, who has been volunteering in Gaza with the Palestinian Australian New Zealand Medical Association (PANZMA) for the last month, said there are significant challenges on the ground.
"We've had a lot of loss of medical facility infrastructure ... and then what is remaining is therefore overwhelmed and currently partly due to the blockade of supplies coming in, it's very under-resourced materially as well," he said.
"I was shocked to see the destruction and the breakdown of the healthcare system here in general and that's resulted in a lot of unnecessary death and harm to people."
Holden said the medical team regularly see patients who have been injured in Israeli attacks, people who are dead on arrival, and perform emergency surgeries.
He said one of his patients was a six-year-old with wounds to the face, head, and left eye after a projectile hit her as she slept in her family's tent.
Awad said since the war began, Gaza's medical system had to be revamped, with many services moved to smaller makeshift clinics run by non-government organisations (NGOs) while hospitals are overwhelmed.
He said there were also no MRI scanners — a crucial medical tool — on the whole Gaza Strip as they had all become damaged and were unable to be fixed due to the war.
"As neurosurgeons, we operate based mostly on MRI scans, seeing them and seeing scans of brains and spines, but not having them available meant we were having to make decisions based on CT scans and that was really, really difficult," he said.
"Operating on young kids with brain tumours and only having CT scans was really quite challenging."
Dr Chris Holden (second from left) and Dr Mohammad Awad (third from left). PANZMA has facilitated international doctors travelling to Gaza to volunteer their expertise. Source: Supplied / PANZMA
Awad said leaving Gaza was "bittersweet", and said he hoped to stay in touch with local doctors and offer support for cases and patient care.
"The sweet was coming back to family and friends and getting out safely. The bitter of course was leaving behind all those people that you know you couldn't help and all the queues of people outside the clinic who are looking to you for care and attention."
Ceasefire negotiations
Since a temporary first phase of expired on 2 March, Israel has rejected opening the second phase of talks, which would require it to negotiate over a permanent end to the war, the main demand of Hamas — the political and military group that rules Gaza.
Israel says it wants to extend the ceasefire's temporary first phase, a proposal backed by the United States' Middle East envoy Steve Witkoff. Hamas says it will resume freeing hostages only under the second phase.
Israel halted aid deliveries into Gaza 13 days ago over the truce deadlock. It has also , which largely halted output from Gaza's main water desalination plant. Hamas labelled it "blackmail", while Israel's energy minister said the government would "use all the tools at our disposal to bring back the hostages".
Palestinians whose homes were destroyed in Israeli attacks come together at a mass Iftar event during the Islamic holy month Ramadan, on Saturday. Source: Getty, Anadolu / Ali Jadallah
Palestinian media said the four men had been collecting firewood needed for cooking in the absence of gas under the blockade. The Israeli military said it had struck several militants attempting to plant a bomb near its forces.
And on Saturday, at least nine Palestinians including three local journalists were killed and others wounded in an Israeli air strike on Gaza's northern Beit Lahiya town, the local health ministry said.
Israel's military said it struck two individuals that it identified as "terrorists" operating a drone threatening forces in Beit Lahiya, later striking several other suspects who it said retrieved the drone equipment and entered a vehicle. It did not explain how it identified them or the drone’s threat.
When it comes to the possibility of violence flaring up again, Holden said he feels "much safer" than most of the population.
While hospitals have come under fire in the past, he believes they offer some protection.
"At least I'm not having to go back to my destroyed house or something which would leave me at much more risk, both from unexploded ordinance, which is left in the rubble, and also from these drone attacks, which I'm not seeing in my medium vicinity," he said.
"So I do feel relatively safe at the moment, much more so than the local population."
The war began when Hamas carried out a cross-border raid into southern Israel on 7 October 2023, killing 1,200 people and capturing 251 hostages, according to Israeli tallies.
Israel's subsequent assault on the Gaza Strip has killed more than 48,000 Palestinians, according to Gaza health officials, and reduced much of the territory to rubble.
With reporting by the Reuters news agency.
