A central Arkansas physician recently returned from volunteering at one of Gaza’s last remaining medical facilities.
Dr. Ahmad Yousaf has worked as a doctor in Little Rock for the last eight years. He says he got into the profession because he cares about people. As he watched the crisis in Gaza unfold through images on social media and news sites, he became overwhelmed with the suffering he saw.
“Eventually it got to the point where me and my wife cried enough watching social media clips that I knew I had to do something more than just kind of sit on the couch and be sad about it,” Yousaf said.
He soon reached a tipping point, and decided to go to Gaza himself, as a volunteer physician.
The idea wasn’t out-of-the-blue for Yousaf. He’s worked with Syrian refugees, in clinics in Ghana and in Haiti before, but he knew working inside an active warzone, in Gaza, would be different. He signed up to travel with MedGlobal, a Non-Government Organization he’d volunteered with on previous mission trips.
Ahmad Yousaf isn’t Palestinian. He doesn’t have family ties to Gaza, he had no reference for what it looked like or how big it was. He quickly learned most people who say they are from Gaza are really talking about Gaza City in the north.
Before the war, Gaza City was the most populated part of the Gaza strip, home to hospitals, universities, and businesses. After October 7, when a Hamas-led attack killed over 1,200 Israelis, and Israel launched a counter attack on Hamas, the people living in Gaza City were forced to the south of the Gaza strip, to Rafah.
In May, the Israel Defence Forces invaded Rafah and closed the border with Egypt–meaning the few people who might have had the resources to leave now had no option but to stay.
Yousaf compared Gaza to Little Rock, where he’s worked as a pediatric internist for the last eight years. Little Rock is 116 square miles. Gaza, in comparison, is 136 square miles, and much denser. The population of the Gaza strip in 2020 was about 2 million, nearly 10 times the population of Little Rock.
When Yousaf arrived in Gaza at the end of June, it felt like being sandwiched between two war zones.
“So everybody’s south of Gaza City, and everybody’s north of Rafah and Khan Younis, into this area called the ‘middle area’ is what they referred to it as, or Deir al-Balah. It’s the only quote-unquote ‘green zone’ in the area,” Yousaf said, adding for civilians, it still didn’t feel safe.
“The civilians had been displaced numerous times, everybody feels discombobulated, it’s chaos, there’s no organization there’s no–the healthcare infrastructure is completely destroyed, systematically and strategically been destroyed,” Yousaf said.
“That doesn’t require a degree in military strategy to appreciate when you’re there, there’s just nothing there.”
Adjusting reality
What Yousaf saw was a space both unlivable and unusable. Even though he had an idea of what to expect before the trip, the reality still shocked him.
“It’s an indescribable thing. It feels like a CGI movie of a post-apocalyptic scene,” Yousaf said. “The words will never articulate what was happening, even videos I took, I have to look at them now and I go, that's not–it’s so much worse, it’s so much–every single building in Rafah was destroyed.”
He described his view as rubble as far as he could see, stretching for miles across the Gaza strip. It felt like a wasteland, he said.
Yousaf also knew that few international eyes were on the ground in Gaza. According to the Committee to Protect Journalists, at least 113 journalists and media workers have been killed while reporting on the crisis.
The Israel Defense Forces, which controls the borders of Gaza, does not allow foreign journalists to enter the Gaza strip.
Yousaf said the absence of media coverage was notable. “We didn’t see those people. [...] And it became really obvious the longer we were there that everything was by design.”
But Yousaf has an M.D. at the end of his name, and was traveling with a program solely focused on giving aid to those in crisis. So when he arrived at his station Al-Aqsa hospital in Deir al-Balah, he knew bearing witness to the suffering he saw would be just as important as providing aid.
And suffering is what he saw in nearly every corner of the hospital.
“The system is completely overwhelmed. All those hospitals that existed in the North are gone. And all the hospitals in the south in Rafah and Khan Younis are gone [...]. And so al-Aqsa is one of the few that hasn’t been completely destroyed.”
Yousaf says Gaza was different from any other crisis he’s seen; a community where clean water, food, housing, medical supplies, infrastructure, and safety had all been destroyed. Yousaf admits he had an opinion before he traveled–that Palestinians were being treated disgracefully and the IDF was placing an unfair amount of military pressure on the civilians. But, he said, he still tried to think about the conflict in a nuanced way.
“It’s a complicated thing, October 7th was a terrible thing that happened,” he said. “Trying to understand and negotiate those things was something that I always try to do in any understanding of these things, but when you’re there there’s only one answer which is that what you’re seeing is a war crime. And war crime after war crime after war crime. There’s nothing else I can use to describe that.”
Gaza over time
Yousaf noticed two big changes while he was in Gaza. The first was the market, which he visited on his first day.
“I just wanted to see what was going on, and there was almost nothing there. Some canned stuff and then pretty much nothing else.”
But on his last day, Yousaf went again, and this time found a much wider selection of products.
“You could get coffee, some fruits and vegetables, canned stuff that wasn’t there before. But everything was in Hebrew, because–because it wasn’t humanitarian aid.”
Yousaf said a merchant told him the products were from Israel, from merchant trucks allowed to cross the border.
Yousaf almost didn’t know what to think.
“It hits you, you know, they starve people and now they’re selling them at six times the price, supplies in the market. That’s what it was for the average Gazan, impossible to buy.”
That’s another thing–there’s not nearly enough food in the markets to support Gaza’s population, but even if there were, few people would be able to afford it.
On his last day in Gaza, Yousaf bought a chicken to treat his ICU team. It cost him the equivalent of $200.
So because of these factors, the constant danger, limited goods, the inflated prices, everyone Yousaf met in Gaza was malnourished. He said he knows that because of his training as a doctor–he’s constantly assessing patients for their level of nutrition.
“Every single adult had what we call signs of cachexia, which is fat pad wasting across your temple area and sunken eyes,” Yousaf said.
Cachexia is a big sign that someone isn’t getting enough to eat, or the right kinds of nutrients. In recent months, aid organizations have reported 96% of Gazans are facing acute levels of food insecurity. Some families have shared stories of eating weeds and animal feed just to stay alive.
“It was quite obvious–these people had been chronically starved over a long period of time,” Yousaf said, adding the situation was even worse for those still in the north of Gaza.
The second change Yousaf noticed was in the hospital.
Yousaf said the crisis was so bad that he couldn’t really be a doctor while he was in Gaza. He provided triage care, he did some high-level nursing for the severely wounded patients he could tend to–but the hospital was always overwhelmed with too many patients, and never enough supplies.
“The buildings don’t work right, the hospitals, the facilities don't work right,” Yousaf said.
“There were no wound care supplies, so we were using the most rudimentary gauze and Betadine–things that like my mom would do to clean wounds on my knee, you know. Like Bernadine, Band-Aid and a kiss. That’s-that’s the level of healthcare people were receiving for massive traumatic injuries.”
Those injuries included degloved wounds, where layers of skin and tissue are torn away from the bone underneath. Yousaf says even in fully equipped hospitals in the U.S., these kinds of wounds have extremely high mortality rates.
Which means the doctors in Gaza have every odd stacked against them. They can’t do their best work because they don’t have the supplies, the space, the support. They just have to do the best they can to help their patients suffer less: wrap their wounds so they have a lesser chance of getting infected; give them ketamine so they feel less pain as they die. And all the while more shelters are being bombed outside the hospital, more patients are coming through the doors, and more people are dying.
“That conflict, that internal conflict with somebody who’s trained to take care of people and try to get them to a certain level of quality care and human dignity–it’s completely destroyed there.” Yousaf said.
Yousaf names one of his Gazan colleagues, Dr. Jehad, who used to be the director of all ICU’s in Gaza before the war. He was working at Al-Shifa Hospital when the IDF laid siege to the facility in search of Hamas leaders, who the IDF claims were hiding in tunnels underneath the hospital. Yousaf said Dr. Jehad refused to leave his patients, describing him as a “superhero”.
Jehad was stuck in Al-Shifa for 50 days, all the while continuing to care for his patients.
Yousaf said Jehad kept the same mentality as he moved from hospital to hospital. Finally, when Jehad arrived at al-Aqsa, he decided to stay in the hospital himself–leaving his wife and children at home while he provided non-stop care at the hospital.
“He was going to sleep there next to his patients pretty much until this was over or he died.”
What’s especially hard for Gazan doctors, Yousaf said, is how close the community is. He compares it to Little Rock, where it’s almost impossible to spend a few days without running into someone you know.
“They all know each other, they all have someone’s family member who married somebody–it’s just that kind of place,” Yousaf said. “That’s just the way Gaza feels.”
So the physicians have had to take care of their families, their friends, their communities with no resources, and no breaks.
Yousaf is acutely aware of the fact that he has a chance to reflect on his experience, while his colleagues in Gaza are still dealing with the conditions on the ground.
Yousaf describes his job in Little Rock–after a particularly hard visit, maybe talking to a family of a patient who is dying, maybe after losing a patient he’s gotten to know, he’ll speak with his peers and sit in that moment, processing how he feels before he moves on to care for the next patient. Holding that kind of space–mentally and physically–is impossible in Gaza.
“[The doctors] didn’t have the emotional space to take or to give, and so, so often they just rolled,” Yousaf said. “Like you would see the glaze in their eyes that we see after real trauma, because that’s what they experience every day, it’s nonstop.”
And despite Yousaf and other international aid workers helping as much as they could at Al-Aqsa, Yousaf says the situation never improved.
The last few days Yousaf was in Gaza, the mass casualty events happened with less and less time in between. A school several neighborhoods away from the hospital was bombed. Then a refugee camp in Deir al-Balah. Then a soccer match.
“It didn’t just not get better,” Yousaf said, “it felt like it got worse.”
The trip lasted from June 26th to July 16th. In just 20 days Ahmad Yousaf watched the same scenes happen over and over and over again. A constant buzzing of drones overhead. Emergency on emergency piling up. No breaks, only wondering if, or when their hospital will be the next target.
“There was a feeling that it was inevitable that the hospital was going to get raided. It was a conversation constantly happening.” Yousaf said.
The dire situation took a toll on Yousaf. He described days where he stood in the trauma bay surrounded by children in various stages of dying. Yousaf said in those moments he didn’t know what to do.
He compared it to his training at a high level trauma center in New York City. He saw a lot of car accidents with one or two people in critical condition. There, Yousaf’s team had a system, a structure to provide care. But even then, the hospital was only equipped to care for one or two people at one time.
In Gaza, anywhere from three to 20 people would stream in the hospital at all hours of the day. And most of the time patients would need more than what the doctors could provide.
“So many of them dead on arrival, so many of them already gone by the time they got to the hospital.”
Yousaf also said the number of casualties in Gaza is much higher than what’s currently being reported. When mass casualty events happen, like the strike on a soccer match on July 10, which Reuters reported killed at least 29 people, the immediate number doesn’t account for everyone who dies as a result of the strike.
“The 100 others who got wounded, who died four days later from a wound infection, or from bleeding, or from a respiratory failure like I mentioned, are not included within those who died from the direct bomb blast.” Yousaf said.
But what makes the casualty numbers even greater, Yousaf says, is–once again–the fact that the healthcare system in Gaza can’t properly treat sick people. Without the hospital infrastructure to support them, patients with chronic diseases suffer exponentially.
Yousaf used diabetes patients as an example.
“There’s no insulin in Gaza because you need refrigeration and there’s no electricity. So every single person on insulin in the last nine months has not received it, and has either already died or suffered a significant morbidity consequence like an amputation from an infected wound or one of those things.” Yousaf said, adding the same is true of nearly everyone with a chronic disease in Gaza.
“If you don’t have that [medical care] for nine months those patients can’t survive in those environments,” Yousaf said. “Right now all the people exposed to the elements–it’s 105 degrees in Gaza, and the real temperature feels like 120 because of the humidity and the lack of movement of air–the tents, people are staying in tents and getting severely dehydrated because the access to water–all the malnourished kids and adults that are dying from regular viral illnesses and regular infections because they’re so malnourished–those numbers aren’t being captured.”
Current reports estimate the number of Palestinians killed since October 7 is around 40,000. A recent article in the public health journal Lancet suggests the death toll could be as high as 186,000. Yousaf thinks the final number, once the crisis is resolved, could reach 400,000.
He said the doctors he worked with agree.
“Every worker there, every aid worker there, every international eye on the ground there had consensus on what was happening.” Yousaf said. “There was no debate about who the ones were that needed the blame placed. There was no debate about what needed to happen next. That only seems to happen in the luxury of air conditioning [in the U.S.].”
And amid the constant emergencies, the chaos, Yousaf changed too.
“When I first got there I was in shock and I was sad, because I didn’t think people were capable of doing what they were doing to these people. And just so you know that’s actually the way they thought, the Gazan people were like ‘ah you know they bomb us every couple of years or so but like, there’s a limit, you know? And they’re like ‘We've just never thought they [the IDF] were capable of this level of inhumanity. So there’s sadness to see people suffering in a way that I never thought was gonna happen in 2024.”
And over time, Yousaf said, he got angry. Angry that people were suffering, and angry at his home country. He said once people in Gaza found out he was from the U.S., they asked him: ‘why are you guys doing this to us?’ and often referenced the U.S.-made bombs Israel uses in it’s strikes on Gaza.
Yousaf said he tried to counter, saying people don’t realize how bad the crisis is, that there are people like himself who care about humanitarian crisis. But, Yousaf said, these answers weren’t satisfying.
On June 28, Reuters reported the Biden Administration has sent more than 10,000 bombs weighing 2,000 pounds each to Israel since the war began in October. In May, President Biden said he would stop the shipments. But on July 10–one day after Israel’s strike on a soccer match killed at least 29 people–the Washington Post reported the U.S. resumed shipments of 500-pound bombs to Israel.
The push for ceasefire
Now that he’s returned to the U.S., Yousaf says he’ll use his energy to keep advocating for the people of Gaza.
“There’s something, I think, obvious to me now, which is that this is probably the most important work I’m going to do for the people of Gaza right, is tell their story, because nobody’s listening to them. Even though they have beautiful voices that people should hear, right now the world doesn’t hear them.”
According to the website ceasefireaction.com, 89 members of congress have signed statements or voted in favor of resolutions supporting a ceasefire in the Middle East, increased humanitarian aid to the region, and the return of the remaining Israeli hostages still held after ten months of conflict.
Local efforts in Arkansas to push for a ceasefire have repeatedly stalled. The group Little Rock for Ceasefire has been unsuccessful in attempts to get local governments to pass a resolution calling for a ceasefire. The Little Rock City Board of Directors has yet to take up the group’s push to add the resolution to their meeting agenda. In June, the Pulaski County Quorum court voted to table the resolution indefinitely, effectively preventing the court from discussing or voting on it again.
Yousaf says he knows sharing what he saw won’t change the world, he says it’s unrealistic to hope for that. But he hopes he can change people’s minds, show them a sliver of what he experienced, and share the stories of the people he grew to love.
“There’s nothing like them. They aren’t defined by their vulnerability and their weakness in this time, they’re defined by their generosity and their resilience and their capacity to love people even though the world hasn’t shown them any love. And you feel it when you’re there.”
The reality that breaks Yousaf’s heart is this: now that he’s home and sharing these stories of what he saw, it likely means he won’t be allowed to return.
“Access to Gaza is controlled by one, one body. And it’s the IDF. And the IDF decides if I get to go back again, and I know that I owe it to the Gazan people to tell their story, and I know at the same time it makes it very likely that I can’t go back during this time which is like [pause], it’s probably the worst feeling I could have but [pause] I think it’s just what I’m supposed to do right now.”
So, Yousaf says, that’s what he’ll do: keep talking about Gaza, share these stories, and remember the love and the pain of this community in crisis.
