Dr Sandy Inglis: Emergency medicine in a conflict zone
““If we ran out of diesel, the hospital would come to a grinding halt. The whole thing is quite precarious.””
My work at the Red Cross Field Hospital on the western side of Rafah, southern Gaza, is with the International Committee of the Red Cross (ICRC), which is an independent, impartial and neutral organisation that only works in areas of conflict. ‘We take action, not sides’. When people are suffering and need urgent medical care, that’s what they do, and they get people on the ground to help.
For the first six weeks in Rafah, back in March, we just had an empty patch of land – the organising stage – and then we had about 20 trucks that came in with equipment from Jordan to set the field hospital up. The whole idea of a field hospital is to set it up to be completely independent, so we try not to draw on any of the local resources, as much as possible. To achieve that, it comes with its own dry food supplies, beds, power and all the equipment and supplies to run a hospital and sustain life – for the patients who come into the hospital, as well as for all the medical and other staff that operate it. Diesel is a big issue. If we ran out of diesel, the hospital would come to a grinding halt. The whole thing is quite precarious.
The Red Cross Field Hospital began operations on May 9, 2024
The field hospital became operational on May 9. I was there for my second rotation when that happened, and the numbers escalated quickly. The hospital itself is a series of canvas tents, with 62 beds in total – maternity beds, pre-op and post-op beds, high-dependency, plus the ED and all the ward beds.
It offers quite comprehensive maternal and newborn care. In the early weeks, there had already been about four caesareans and about thirty normal births, plus a range of other complicated issues.
One team operates while the other reviews ward patients and new emergencies and then the teams rotate every six weeks. Resources are limited and supply chains precarious. It’s a stressful way to work. Behind all the medical tents there are the support tents with the equipment and the engineering and technical experts. They were critical in the set-up stage and built or installed all the sanitation, septic tanks, the incinerators, and electrical and water purification systems. Our water comes from two wells nearby and it’s incredibly saline – very salty water – so it all has to be filtered and purified by reverse osmosis.
““The doctors and nurses I work with aren’t strangers to what we call mass casualty events – critical situations that typically overwhelm the standard equipment and staff levels.””
I was very much involved with the recent mass casualty with 22 dead and over 60 casualties on June 21 when the displacement camp near to the field hospital was hit. Within minutes, we began receiving patients.
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 hospital’s tent walls jerked as the shockwaves reverberated. We quickly realised what would be coming, and most staff – locals and foreigners – went to the emergency department to prepare. But there was no time to prepare. In the chaos of war, you adapt.
I stood at the hospital entrance as ambulances came screeching in, at times sliding to a stop, with paramedics piling out to grab stretchers, directing each patient to the appropriate area of our hospital, categorised by colour.
The 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.
““Self-care here, surrounded by the noise of war, looks very different than it does in a regular ED.””
The 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 black area: a corpse, burned so badly as to be unrecognisable, wrapped in a sheet and sent to our morgue.
The doctors and nurses I work with aren’t strangers to what we call mass casualty events – critical situations that typically overwhelm the standard equipment and staff levels. Sadly, that week, we had three of these events.
Some will recover and live life without a limb. It’s the mental toll - particularly for children who have lost parents or been so terribly injured – that will go on and on for years to come. I worry about this – and the worry stays with me.
As someone providing medical aid amidst this chaos, self-care is important but the reality of applying it can be challenging. Self-care here, surrounded by the noise of war, looks very different than it does in a regular ED.
All around you, family members are screaming, people grieving, bystanders shouting. The staff are clearly traumatised, but they simply continue working. That’s what they’re here to do.
The noise is constant. It’s not just the explosions. The whine of drones flying around seems to never end. You think you have got used to it, until there’s a moment of silence and then you realise how much it dominates your life here.
I find those brief moments of silence in the early hours of the morning, sitting out on the flat rooftop of the house that is home to many of the medical staff working here with the ICRC. I look out over the scarred landscape, and do yoga as a form of meditation, but the silence is so fragile. Then the noise starts again.
““You can’t be the same person you were before.””
Experiences like this – the endless trauma of other people’s grief and pain and the natural fear you feel for your own life at times – changes you. You can’t be the same person you were before. But in emergency medicine, we are trained to help people who need emergency medical care. Sadly, because of conflict and war, there will always be somewhere in the world where people need that help.
