HAIFA, Israel — Working on just a few hours of sleep and relying on a generator to power their medical equipment, a surgical team worked to save the life of a man suffering complications from a liver transplant. It was an established but advanced procedure in the medical world, inserting a stent to drain bile from the organ. But they ended up guiding this tiny tube into the liver with wires pulled off another stent, intended for urological procedures, and hoped their hack would work.
Such off-label use of medical equipment would not be allowed in most developed countries. But this surgery was done in Gaza, now facing severe shortages of food, gas, medicine and other essential products as Israel and Egypt have tightened their borders out of security concerns. Internal Palestinian political conflict has also disrupted the flow of goods into the enclave.
“This is not what the equipment was made for, but we needed to save his life and this stent was all we had,” recalls Dr. Iyad Khamaysi, a senior physician in the gastroenterology and hepatology departments at Rambam Medical Center in Haifa. Khamaysi is one of a small number of doctors from Israel who regularly make the short but complicated journey to Gaza under the direction of the nongovernmental organization Physicians for Human Rights Israel to treat patients, train physicians and deliver medical equipment.
The work done by Khamaysi and other doctors traveling into Gaza has taken on a new urgency amid the violence that has hit Gaza in recent weeks, partly to protest the opening of the U.S. Embassy in Jerusalem, a contentious move that American presidents have avoided for decades. Events grew bloodier this week as Israeli forces fired on Palestinian crowds gathered at the Gaza border, leaving dozens dead and injuring thousands more. Israeli officials said many of the Palestinians killed had ties to the militant group Hamas and others were engaging in violence and trying to breach the border fence.
As Khamaysi recounted this surgery during a recent interview in his office in Haifa, he fielded messages from doctors he met in Gaza, sending him ultrasound images to get his expert opinion, asking him for help to bring a patient to Israel and when he plans to visit again.
Every year thousands of patients from Gaza receive medical care in Israel, but these low-profile Israeli medical missions to Gaza and the subsequent daily professional communications between doctors on both sides of the border also impact the lives of hundreds of patients in Gaza.
“The collaboration, it’s amazing” says Dr. Khaled Matar, director of the gastroenterology department at the public European Hospital in Khan Younis in Gaza, where Khamaysi visits a few times a year, and has helped establish an advanced endoscopy unit. “It’s been very beneficial to our patients and to our team, and we can help more people this way.”
Matar and Khamaysi say the cooperation is even more essential now, as the humanitarian situation in Gaza worsens. The Israeli-run Kerem Shalom crossing point for goods to enter Gaza from Israel is only working at partial capacity after Palestinians recently damaged it as part of the ongoing protests against Israeli policies toward Gaza that started in March. The Palestinian Authority, ruled by the Fatah party, has cut salaries for public sector workers — including doctor and nurses — in Hamas-ruled Gaza, along with funding for electricity, and delivery of medical supplies, part of an ongoing political conflict between the two Palestinian parties.
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There is currently a 40 percent shortage of essential medications, no clean tap water and only a few hours of electricity a day, says Gerald Rockenschaub, director of the World Health Organization’s offices in the West Bank and Gaza. Hospitals have also had an influx of thousands of patients in recent weeks who were injured by Israeli military responses to protests rioting on the Gaza border, Rockenschaub says.
“The current situation is obviously a crisis on top of a chronic crisis,” Rockenschaub says.
The last few years have also seen a decline in the number of patients from Gaza receiving medical treatment in Egypt and Israel, both longtime destinations for specialized care among Gazans. Egypt has shuttered its border with Gaza, and Israel has approved fewer entries for medical treatment, totaling 29,113 in 2017, down from 35,647 in 2016, according to the office of the Coordination of Government Activities in the Territories, the Israeli defense department unit that facilitates the crossing of goods and people into and out of Gaza.
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Some Palestinian patients approved for treatment in Israel have also reported threats from Hamas, which suspects them of collaborating with Israeli security officials in return for or during their medical care, according to officials at NGOs.
“Patients are requested to leave their mobile phones behind, or told not to go,” says Mor Efrat coordinator for activities in the Occupied Palestinian Territories at Physicians for Human Rights Israel, which also works to help facilitate the transfer of patients from Gaza into Israel. “It’s very scary for the patient.”
[READ: Gaza on the Brink]
It is against this backdrop that Khamaysi and Matar continue to work together. Physicians for Human Rights Israel first asked Khamaysi to travel to Gaza in 2015.
“In the beginning I was afraid to go there,” says Khamaysi, who lives with his wife and four children in Kfar Kana, a mixed Muslim-Christian city in northern Israel that Christians believe is where Jesus turned water into wine. In addition to his medical expertise, Khamaysi also was invited on the mission because he is part of Israel’s Arab minority; as the Israeli military does not allow Jewish Israeli doctors enter Gaza out of security concerns.
But even though Khamaysi shares a language and some cultural ties with Gaza, it was a foreign place that he, like most Israeli citizens, had never been. “I didn’t know anyone in Gaza, and I was afraid someone could target us for being from Israel.” But he understood that his expertise was desperately needed, so he went.
Since that first visit, Khamaysi has been to Gaza seven times. During each visit he sees patients in Matar’s gastroenterology clinic at the European Hospital, performs surgeries and lectures local doctors on the latest techniques and technology for treating liver and digestive diseases. Because his visits are limited to two days, he works around the clock and broadcasts his surgeries on video for doctors to watch from an adjacent room, where they can also ask him questions. The work has recently resulted in training enough doctors and importing enough equipment to establish an advanced endoscopy unit at the hospital.
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This has resulted in fewer patients from Gaza needing to travel to Israel or Egypt for procedures, Matar says.
But major challenges still remain. In April, Matar’s gastroscope broke, and needs to be sent back to Germany to be repaired, a process he fears will take many months.
“Meanwhile, we cannot help people, we cannot check them, I just had three cases this morning,” Matar says in a recent phone interview from Gaza. He also says he fears that his other equipment will also soon become useless as he is running low on the disposable parts needed to use them.
“When you run out of such things, you stop working.”
Israeli officials have blamed Hamas for the situation, saying the group, which Israel, the United States and other countries label a terrorist organization, is encouraging vandalism of infrastructure and preventing the delivery of humanitarian supplies that enter through Israel in order to gain more sympathy from the world.
Hamas has denied such charges and blames Israel’s decade-long blockade for the dire humanitarian situation and ongoing volatility.
Meanwhile, Matar and Khamaysi are busy narrowing down which patients he will see during his next visit, scheduled for early June.
“It’s really overwhelming,” Khamaysi says. “Whenever I go there I see so many people in the halls of the hospital, bleeding and sick and I can’t help everyone.”
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