At Gaza’s al-Shifa Hospital, nothing is sterilised, so Dr Jamal Salha and other surgeons wash their instruments in soap. Infections are rampant. The stench of medical waste is overwhelming. And flies are everywhere.
Without painkillers, patients moan while lying on metal beds lining the corridors. There’s no electricity and no ventilation amid searing heat, leaving anxious visitors to fan bedridden relatives with pieces of cardboard.
Al-Shifa Hospital, once the largest hospital in Gaza and the cornerstone of its healthcare system, is a shell of its former self after 22 months of war.
The hospital complex, the size of seven football pitches, has been devastated by frequent bombings, two Israeli raids and blockades on food, medicine and equipment. Its exhausted staff works around the clock to save lives.
“It is so bad, no one can imagine,” said Salha, a 27-year-old neurosurgeon who, like countless doctors in Gaza, trained at al-Shifa Hospital after medical school and hopes to end his career there.
Al-Shifa Hospital was initially part of a British military post when it opened in 1946. It developed over the years to boast Gaza’s largest specialised surgery department, with over 21 operating theatres. Now, there are only three, and they barely function.
Because al-Shifa Hospital's operating theatres are always full, surgeries are also performed in the emergency room, and some of the wounded must be turned away. Bombed-out buildings loom over a courtyard filled with patients and surrounded by mounds of rubble.
Salha fled northern Gaza at the start of the war — and only returned at the beginning of this year. While working at another extremely busy hospital in central Gaza, he kept tabs on al-Shifa Hospital's worsening condition.
“I had seen pictures," he said. "But when I first got back, I didn’t want to enter.”
A young doctor and a war
After graduating from medical school in 2022, Salha spent a year training at al-Shifa Hospital. That is when he and a friend, Bilal, decided to specialise in neurosurgery.
For the first few weeks of the war, Salha was an intern. Because Israel had cut off Gaza's internet service, one of Salha's jobs was to bring scans to doctors around the complex. He had to navigate through thousands of displaced people sheltering there and run up and down stairwells when lifts stopped working.
Once Israeli troops moved into northern Gaza, he and his family left. Bilal, who stayed in Gaza City, was killed a few months later, Salha said.
Not long after Salha left, Israeli forces raided al-Shifa Hospital for the first time in November 2023.
Israeli forces returned in March 2024.
The hospital was left in ruins. The World Health Organization said three hospital buildings were extensively damaged and that its oxygen plant and most equipment were destroyed, including 14 baby incubators.
While all this was going on, Salha worked at a hospital in central Gaza, where he performed over 200 surgeries and procedures, including dozens of operations on fractured skulls. Some surgeons spend a lifetime without ever seeing one.
When he returned to Shifa as a neurosurgeon resident, the buildings he used to run between felt haunted.
“They destroyed all our memories,” he said.
A shrunken hospital is stretched to its limits
On a recent morning, in a storage room-turned-patient ward, Salha checked up on Mosab al-Dibs, a 14-year-old boy suffering from a severe head injury and malnutrition.
“Look how bad things have gotten,” Salha said, pulling at al-Dibs’ frail arm.
Al-Dibs’ mother, Shahinez, was despondent. “We’ve known al-Shifa Hospital since we were kids; whoever goes to it will be cured,” she said. “Now, anyone who goes to it is lost. There’s no medicine, no serums. It’s a hospital in name only.”
There are shortages of basic supplies, like gauze, so patients' dressings are changed infrequently. Gel foams that stop bleeding are rationed.
Patients wait for hours and sometimes days as surgeons prioritise their caseload or as they arrange scans. Some patients have died while waiting, Salha said.
After months without a pneumatic surgical drill to cut through bones, Shifa finally got one. But the blades were missing, and spare parts were not available, Salha said.
“So instead of 10 minutes, it could take over an hour just to cut the skull bones,” he said.
“It leaves us exhausted and endangers the life of the patient.”
Unforgettable moments
From his time at the hospital in central Gaza, Salha can't shake the memory of the woman in her 20s who arrived with a curable brain hemorrhage. The hospital wouldn’t admit her because there were no beds available in the intensive care unit.
“Sometimes it seems we are living in a stupor. We deal with patients in our sleep, and after a while, we wake up and ask, what just happened?”
Salha’s story, while striking, is far from unique.
He is one of many young medical students in Gaza thrust into roles well beyond their training, as a devastated health system buckles under the weight of Israeli attacks and blockade.
