As palliative care practitioners, our motivation is driven by healing, hope and common humanity. Broadly defined, palliative care is care — social, emotional, spiritual and physical — for a person and their family affected by serious illness and those at the end of their life, and bereavement care after somebody has died. It aims to improve dignity and quality of life in the face of health suffering.
Eight years ago, we were invited by healthcare colleagues in Gaza to collaborate to support plans towards improving palliative care. The former dean of the medical school at the Islamic University of Gaza, Dr Fadel Naim, told us, “I have the vision of training healers, not just doctors.”
The director of the Turkish-Palestinian Friendship Hospital — Gaza’s only hospital for cancer care — Dr Sobhi Skaik said, “Our people are in pain, we need to act.” During visits to Gaza, we have helped develop undergraduate palliative care training for medical students at the university, and later a postgraduate palliative care diploma at the hospital.
At the end of October this year, we were to celebrate our first diploma graduates — including doctors, pharmacists, physiotherapists, a psychologist and a nutritionist. The party was planned with exquisite Palestinian food and joyous singing. We were to play the song “Insan (A human)” by Egyptian singer-songwriter Hamza Namira, with lyrics that symbolise to the students the essence of palliative care:
A human being inside you and me
A human being who has a dream and an aim
Inside his heart and in the depth of his eyes
He carries hope, sunrise and life
A human being who loves and never hates
A human being who has hope for a better tomorrow
How rapidly these dreams of healing and hope have evaporated. Last week, the Islamic University of Gaza, a place of learning, teaching and hopes for Gaza’s bright future doctors, was destroyed by Israeli strikes. Our palliative care students and their teachers have been scattered to the high winds, losing possessions, homes and lives.
The home of the first palliative care program for the poorest people of Gaza, Al-Ahli Arab Hospital, was this week destroyed in a horrific attack — Palestinian officials blame an Israeli airstrike; Israel says responsibility lies with a Palestinian Islamic Jihad militant group, which has denied blame — that killed 471 people, including children, healthcare staff, and displaced families seeking shelter.
The hospital, with its palliative care program, is no longer operational. The Turkish-Palestinian Friendship Hospital which cares for 9,000 cancer and palliative care patients is on the verge of complete shutdown owing to the blockade of fuel and essential medical supplies.
Over the last 11 days, our colleagues have been reaching out to us intermittently via WhatsApp, during the brief periods when phones are charged.
Dr Khamis Elessi, a neurorehabilitation and pain medicine doctor, and a champion of palliative care in Gaza, wrote, “I condemn killing of every kind, including what happened in Israel. But punish those who did it and not innocent civilians.” Next to a photo of a row of shrouded, dead children, he captions, “I leave these photos for you to judge. We are being exterminated on TV.”
Merrain Hammad, a nutritionist with plans to study cancer care and nutrition in Malaysia, wrote of the instructions to evacuate Gaza, “May God stand by us. Four days running from house to house and in the end from a city to another. Nowhere is safe.”
Rida Imad Almadhoon, a gentle nurse with an infectious laugh who worked at Al-Ahli Arab, messaged before the hospital destruction, “I am confined to the hospital where I currently work and I cannot go out to see my family or even return home if it has stayed. Whoever leaves his place carries his soul on his palm.”
Suad Jameel Saleh Redwan, a skilled physiotherapist in rehabilitation and palliative care, messaged, “It’s very painful when our children hear strong bombs and we wonder whom we will lose. A mother’s eyes contain her children, and yet can lose them in the same second.”
Messages of fear and panic are giving way to exhaustion and a grave resignation. Gazans are writing their own eulogies.
Mahmoud Hammad Ihmedan Abu Saqer, a confident nurse who goes dewy-eyed when showing photos of his firstborn son, has been saying his farewells: “Maybe these are our last hours. Maybe we are next to God, so whoever carries something from us in his heart, and to God, is nothing but a relief. Forgive us and pray for us.”
Wala Fathi Abu-Muaileq, a smartly dressed, caring nurse tells us, “The heart bleeds and the eye sheds tears over what it sees, but the mind thinks and is certain that the next scene is me.”
“We smell death in every breath,” writes another doctor.
Suha Suleiman is a senior pharmacist advocating for access to pain relief for Gaza’s cancer patients. She recently became a proud grandmother. Suha tells us that three days ago, her sister-in-law and six young nieces and nephews were killed by a missile. Suha says, “Gaza, the beautiful city which you knew and loved, has become a city of ghosts. All its buildings, streets, schools, trees, completely destroyed. We are without any life support.”
She writes in past tense — “The world became blind and deaf to our suffering. We didn’t ask for more than life with peace and dignity like all people over the world. I had a house, I had a friend, I had a place, I had a tree, I had a bird and a cat, I had a family, I had a brief homeland in a prison. It was called Gaza.”
“What is palliative care?” we always ask our Gazan palliative care students. “Palliative care is humanity until infinity,” writes one.
In the past 24 hours, the messages have fallen silent.
