Speaking to Tribune, British surgeon Nick Maynard described the realities of Israeli collective punishment that he witnessed in Gaza: patients dying on dirty floors, sheltering from constant bomb attacks and receiving serious surgery without anaesthetic.

An injured Palestinian child receives treatment at Kuwait Hospital after Israeli air strikes in Rafah. (Photo by Ahmad Hasaballah/Getty Images)

Gaza’s health system was on the brink of collapse long before October 2023. The densely populated coastal enclave, home to more than two million Palestinians, had been under siege by Israel for 16 years, a policy which tightly limited the movement of people, food, fuel, building materials and more in and out. A 2022 briefing paper by Medical Aid for Palestinians outlined some of the predictable consequences: frequent unavailability of essential materials and equipment, providers forced to adopt austerity plans to afford generators and alternative power sources, patients required to apply and wait for Israeli permission to leave Gaza to receive treatment services—like radiotherapy, genetic medicine, and certain cardiac surgeries—completely unavailable there.

The infrastructure that did exist last year—36 hospitals, an average of 1.26 hospital beds for every 1,000 people—has now suffered a brutal bombardment by Israeli forces. There are no fully functional hospitals left in Gaza. Just 13 are partially functioning, and they and those who staff them remain under constant attack.

Professor Nick Maynard, a leading British consultant surgeon, has travelled to the West Bank and Gaza with surgical and teaching delegations regularly since 2005. On those trips he has taught in medical schools, performed cancer surgeries, and helped Palestinian hospitals develop their own services. In December 2023 he visited again, this time on a two-week mission with Medical Aid for Palestinians as part of the WHO Emergency Medical Team at Al-Aqsa hospital. Now returned to Britain, he sat down with Tribune to share his experience on the frontline.

Taj Ali

What were your impressions of Gaza before this bombardment?

Nick Maynard

I fell in love with Gaza the minute I went there. It’s a beautiful place, and the Gazan people are beautiful. But that’s not to understate the massive problems they have there. There are always huge challenges working in the healthcare sector because of the lack of resources and the restrictions on healthcare caused by Israel’s siege. So it’s always been very challenging, too.

Taj Ali

It’s a brave decision to go to Gaza and work in these hospitals knowing your own life is at risk. What motivated you?

Nick Maynard

Prior to October 7, I already had two trips planned, one in October and one in November. They were cancelled for obvious reasons. But I spoke to the people who run Medical Aid for Palestinians, the wonderful charity I go in with, and I said I wanted to go in with the first team they sent.

I have two main motivations. First, I have an overwhelming feeling of what is just and what is unjust in this world. I was appalled by the events of October 7. I would never condone what the Hamas militants did. It was shocking. But I have been so appalled by the response and the mass killing of Gazans that I felt it was profoundly unjust. And because I could contribute, I felt I had a duty to go in.

The second motivation is that I have many friends in Gaza, and one family in particular, the Alaloul family. I taught their daughter Enas as a medical student in Gaza about nine years ago. She got a scholarship, and she’s now working as a doctor in England. My wife and I have essentially adopted her because she can’t see her family. When Enas got married in England, I walked her down the aisle. She’s very close to my children. I felt I couldn’t look her or her family in the face ever again unless I went out and helped them.

Taj Ali

What were those first few days in Gaza like? What were you seeing?

Nick Maynard

There were three things that immediately struck me when I got into Rafah. The first was the smell of the smoke and burning from the bombs. We all smelled it straight away. The second was the smoke in the sky, hanging like a sort of low-lying cloud.

The third was the unbelievable crowding from the mass movement of Gazans from middle Gaza down towards the south. As we drove from Rafah to where we were staying, we saw hundreds upon hundreds of vehicles packed with families and their belongings, migrating south. It was a mass migration, the likes of which I’ve never seen in my life.

Taj Ali

What was your experience like working in the hospital?

Nick Maynard

Again, there was huge overcrowding. The area surrounding the hospital was packed with many thousands who had moved there for shelter. The hospital itself was at about three or four times normal capacity, with patients everywhere you looked.

And then the injuries were just appalling. Horrific burns, particularly in children. We saw burns so bad in some children that we knew they had no chance of survival, but there was nothing we could do to treat them. You couldn’t even give them pain relief because often there was no morphine there. There was nowhere for them to die with dignity. So they were literally lying on the floor of the emergency department, dying.

We saw traumatic amputations in adults, and a lot of children with legs and arms having been amputated by the bombs. Sometimes those limbs had only been partly amputated and were literally hanging off by a bit of flesh, so they had to have the amputations completed. In order to get bandages on to stop the bleeding, they had to be completed in ED, often without any anaesthetic.

And then we saw a lot of explosive blast injuries from the bombs to the abdomen and the chest. That’s what I spent every day operating on.

There was a great lack of equipment. As well as no morphine there was often no antibiotics in the operating theatres. We sometimes had to operate without any running water so we couldn’t scrub up properly. We had to use alcohol gel to clean our hands. There were days when we had no sterile drapes to cover patients with on the operating table, so we had to make our own out of gowns and other pieces of cloth. We had a real lack of many surgical instruments so we had to make use of what was available. We had a great lack of different types of sutures. We had to just use what we had.

One of the most tragic things was the knowledge that we saw patients who might have been saved if all the resources were there, if the capacity was there. There were patients I remember who could have been saved. That was desperately, desperately sad.

Taj Ali

My understanding from the World Health Organisation is that only 13 of the 36 hospitals in Gaza are functioning, and even then only partially functioning. Can you outline what it means for a hospital in Gaza to be ‘partially functioning’?

Nick Maynard

I actually think a partially functioning hospital is probably a non-functioning hospital. Al-Aqsa Hospital was officially fully functioning when I was there, but I would say it was actually hardly functioning.

Some of the ‘partially functioning’ hospitals are struggling to provide anything resembling normal healthcare. None of these hospitals are able to provide a proper service to people who are ill. They’re providing a trauma service, but they can’t provide normal healthcare to all the other diseases: heart disease, kidney disease, cancer. So they’re not being treated at all.

Taj Ali

That must mean that when we’re talking about the death toll in Gaza, there’s also the knock-on impact on other patients who might not have been killed directly by bombardment but can’t get the treatment they need. And, of course, there’s also the spread of waterborne disease and dehydration. The pressure must be unimaginable.

Nick Maynard

Every square foot of the hospital was packed with patients and their relatives. The stairwells were packed with patients, many lying on the floor. People would find their way to the doctor’s offices and walk in saying, ‘Please, can someone treat me?’ And, as I said, if it wasn’t trauma, very little got treated. So I think the things you’re talking about—cancer deaths, deaths from communicable diseases, deaths from non-communicable diseases like cancer, heart disease, kidney disease, diabetes—will probably dwarf the number of deaths due to trauma. It may well approach 100,000, if not more.

Taj Ali

Irfan Galaria, an American doctor who recently returned from Gaza, described it as ‘annihilation’. He recounted seeing children with single sniper shots to the head in emergency rooms. The narrative we hear from the Israelis is that they don’t target civilians, and yet based on what you and other doctors are saying, that does not seem to be the case.

Nick Maynard

Absolutely not. I saw what I consider incontrovertible evidence of children and women being targeted. We saw multiple injuries to women and small children. Awful injuries. We saw injuries to young men as well. The narrative being peddled by the Israelis that they’re only targeting young male militants is completely false, in my view. I operated on more women than men.

Taj Ali

Israel has some of the most sophisticated precision-based military technology in the world, and yet what we’re seeing is the carpet bombing of hospitals and the wholesale destruction of health services. Many believe that this is actually about making Gaza uninhabitable.

Nick Maynard

Most certainly. To me it’s blindingly obvious that that is what is happening. There is direct, deliberate, systematic targeting of healthcare buildings, infrastructure and healthcare workers taking place, with many healthcare workers being killed and many healthcare workers also having been abducted.

Taj Ali

The Israeli narrative is that hospitals are targeted because they have Hamas militants within them and tunnels underneath. What do you make of that narrative?

Nick Maynard

I can only talk from what I’ve seen, but for the two weeks I was in Al-Aqsa Hospital in Gaza, I spent all day every day there, went to every single part of the hospital regularly, and saw zero evidence of any Hamas militants in it.

Over many years of visiting Gaza I’ve spent a lot of time in Al-Shifa hospital, too, and in the European Hospital, and in Nasser Medical Complex. I have never seen any evidence of Hamas militants in hospitals at all. I think the evidence provided by the IDF suggesting there are command centres in the hospitals themselves is not remotely credible.

Taj Ali

The Israelis told the Palestinians to move to Rafah to escape the fighting and now they’re saying they’re going to launch a ground invasion off Rafah. Do you think this was the end goal of the Israelis? To take the Palestinians out of Gaza, to depopulate it?

Nick Maynard

I do. Based on discussions I’ve had with people and what I’ve seen with my own eyes, it seems to me very that their end game is getting the Gazan population out of Gaza and into Egypt.

Taj Ali

There’s a great deal of dissatisfaction with the responses from our politicians to what’s unfolding in Gaza. Politicians spend an awful deal of time debating semantics. A ceasefire, they say, must be sustainable. Based on your own experience, what should our political leaders be doing?

Nick Maynard

There are clearly many decisions that need to be made about the long-term future. But in the immediate term,  I cannot begin to understand why some governments, particularly the UK and US governments, are not pushing for an immediate, permanent, and unconditional ceasefire from both sides. They need to be pushing for that. I don’t think pushing for a ‘sustainable ceasefire’ or ‘humanitarian pause’ is of any benefit at all. They need to go for an immediate, permanent ceasefire.

When you talk to people in Gaza, that is all they want. They don’t want a humanitarian pause. The last humanitarian pause made no difference; the aid that got in couldn’t be distributed. The only thing that will make a difference now, that will stop this humanitarian catastrophe, is immediate and permanent ceasefire.

Taj Ali

Sadly, even an immediate ceasefire doesn’t seem like it will be enough to prevent further loss of life as a result of the ongoing siege. Reconstruction efforts will be made very difficult by the intensification of it, won’t they?

Nick Maynard

The rebuilding is an unimaginably huge task ahead of everyone. It’s going to take many years to rebuild what’s been destroyed. We’ve only been talking about the healthcare system, but there’s all the schools and universities that have been destroyed too. The churches as well. Rebuilding will take many, many years and a vast amount of money. And it cannot start until there is a complete ceasefire.

Taj Ali

Finally, if you had a message for those who are concerned about what’s happening and want to help, what would it be?

Nick Maynard

I think this is the most important thing going on in the world at the moment, bar none. How we act during this catastrophe will define us all as individuals, as societies, and as governments. Everyone can do something. Not everyone has skills they can take into Gaza, but we can all help in our own ways.

I also think people need to educate themselves, educate others, talk about it. More people need to learn about the true background to this catastrophe. No one condones what happened on October 7, but everyone needs to understand this did not start on October 7. We have a duty to learn, to educate others, and to talk, to raise awareness.

Civil action is very important in this, too. We can all go on marches. They’re not ‘hate marches’, as some in the media and the government claim. They are peace marches. Marches representative of the vast majority, who simply want the killing to stop.

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