A Public Health Catastrophe in Gaza

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Rates of seasonal infectious disease have hit their winter peak as they finally start to trend downward. The Dana-Farber Cancer Institute retracts dozens of articles by top executives. The Ohio legislature overturns a governor's veto to ban gender-affirming care. This is America Dissected. I'm your host, Dr.

Abdul-Walseid.

For nearly the past four months, Gaza, that tiny, densely packed strip of land not larger than the city of Detroit, has experienced an unprecedented bombardment at the hands of the Israeli military. In its scale, scope, and ferocity, it's one of the most devastating attacks on a civilian population in our lifetimes. Make no mistake, the terrorist attack that kicked us all off on October 7th is a terrible atrocity on its own terms. And, as I've done and will continue to do, I condemn Hamas and its brutal violence on that day. All hostages must be freed.

But if we believe in the sanctity of all human life, we have to reject any notion that, because one attack was brutal and inhumane, that it justifies brutality and inhumanity, particularly at the scale and speed that we've seen it play out. in Gaza. 25,000 people have been killed, more than 10,000 of them children. 10,000.. Think about that.

And that's in barely more than 100 days. That's like crashing an airplane full of children every day for 100 straight days. But, as we've discussed on this podcast, there's a way that statistics perpetuate a sort of civic violence by sanding away the humanity of the people underneath them. It's like stacking up a mountain of bodies and zooming out far enough so that you actually believe it's just a mountain, rather than a mountain built of snuffed out dreams. Every one of those kids wanted to be something when they grew up.

They all cuddled their moms and dads and siblings. They had a favorite food. They're just like our kids. And they're just the ones who've died. Our society has come a long way on acknowledging the mental health of young people, how bullying or neglect can impact a life.

Now imagine how watching your sister die in front of you, or losing your parents in a bombing at seven years old might shape your life. Those kids don't get counted in the death numbers. They've just had to create new numbers. As you all know, I'm an epidemiologist, a terrible field of science dedicated to counting people's misery. We do it in the hope that if we can count and define it clearly, then we can spur change.

In Gaza, they've taken to counting children's legs. Since the bombardment began, an average of 10 children per day have lost their legs. Perhaps if children's lives don't demonstrate the extent of the suffering, their legs might. In Gaza, there are so many children who are taken to hospitals, injured in attacks in which their entire families have died, that they created a new acronym for it, ICNSF, Injured Child, No Surviving Family. But there are now far fewer hospitals that can treat ICNSFs.

Every one of Gaza's 36 hospitals has come under Israeli fire, not to mention countless reports of bombed ambulances and healthcare providers killed. To be clear, any attack on a hospital, ambulance, or healthcare provider is a stark violation of international law, an indirect targeting of the civilians those healthcare providers are intended to render services to. International outrage has been profound, prompting South Africa to bring a genocide case against Israel in the International Court of Justice, for which the court formally found a basis in its preliminary ruling on Friday. And yet all of this has had little to no effect in the single country that has done the most to support this, our own. The devastation of Gaza was underwritten by our political power, our vetoes in the UN Security Council, our tax dollars, and our 2,000 pound bombs.

One of the common refrains you hear from apologists of our government's actions is that it's somehow unfair to single out Israel. But what Israel has done in Gaza is singular. It has no parallel. in this century. They literally killed 1% of Gaza's population.

The equivalent in our country would be 3.

5 million people. And yet we defend, no, extend it. And at core, it's not even really about Israel. It's about the value of human life. Our failure as a global community, as humans generally, to stop the murder of 10,000 children in just over 100 days or to hold the murderers accountable is passive acceptance that this kind of violence can even be justified.

It creates a permission structure for genocide that, I worry, ill-intended dictators and would-be mass murderers are taking notes on. This violence needs to end. There must be a ceasefire. I wanted to understand what it's like on the ground for the people of Gaza, so I reached out to a friend and a former classmate, Dr. Tania Haj-Hassan, a pediatric intensivist and physician with Doctors Without Borders, who served in Gaza and has been communicating with her colleagues there.

Here's my conversation with Dr. Tania Haj-Hassan.

And it's a very long process until you finally get to the other side. And then there's about a kilometer or so, it feels like a kilometer, where you walk in this cage, until you finally are welcomed at the other end of it by our Gazan colleagues, who are the warmest people I've had the privilege of working with. Gaza itself is a beautiful city. Not so much because it's flourishing or beautiful in the way you would describe Switzerland, for example, but it just exudes warmth. And it's on the coast, and people there really love life, you can feel it.

You can feel it as you walk along the beach, and there's like little shanty shacks everywhere, but people are out playing volleyball or football or swimming, and really making the most out of very, very difficult circumstances. So the first time I went, I think I was just, one, very shocked at how difficult it is to get to the other side, and how much it felt like I was trying to enter a high-security prison only to find not dangerous, convicted people, but innocent families making the most out of what are very difficult circumstances. They're clearly poor for the most part, but really well-educated, very much value education and hard work. And I think that was the third thing that struck me, was how committed our students that we taught were. So I was teaching at two medical schools, and then also teaching, bedside teaching in the hospitals.

And just how absolutely determined the students were to learn, both the men and women. And we'd take coffee breaks together, and I was also just struck by how warm they all were and how positive they were. I was also very struck at some of the answers they gave me to questions that I asked about what they envisioned as a future for themselves. And I think the majority of them, and I'm trying to think, if I can remember any different, but, you know, were happy to live at peace. if, you know, if the siege was lifted, they were happy to live side-by-side with Israelis as long as they were well-respected and protected and were given equal rights.

And I think, for people who've never, some of them had never seen an Israeli before, you know, they've never left the Gaza Strip, and a lot of the wars have been waged remotely with bombs, and so they hadn't really seen people outside of the Gaza Strip, but still, despite that, were able to envision a future of peace and cohabitation. That obviously changed year after year. that we went. I think, not the sentiments, or the warmth.

And so this, you'd smell the stench when you crossed over into Gaza. You know, they were getting only a few hours of electricity per day, which means they find it very hard to power a lot of the plants that need to, to maintain those standards. Same thing when it comes to clean water. And then just the living situation for so many people was worse. I remember going on a run with my team and we were talking about the fact that we hadn't seen dead rats on any of our previous trips, but we had that one time in one of the refugee camps.

I think just things were getting worse from a humanitarian standpoint. But the attitudes, at least my perspective of it was, they hadn't changed. They were still warm, kind, positive, and, you know, really trying so hard to love life. Just an excellent sense of humor always, and a warmth and generosity that always surprised us, knowing what they were having to endure.

And can you tell us a little bit about what they share?

And during those period, it is really hard to stay in touch with them. I heard from two of my colleagues this morning, and I can at least maybe share what they shared with me this morning.

This particular doctor evacuated south. His family is in the middle area. He wasn't able to reach them because it's not safe. So he's now in the south with no money to buy a tent and no family, and is desperately looking for a job or any job, both so that he can continue to have a sense of purpose and offer his services at a time when people are, as you and I are, I'm sure, just determined to help in any way possible, and also so he can earn some money and buy a tent. This is a very well-educated, well-trained doctor who had a decent quality of life.

He's one of the best doctors I know, and he's alone with not even the means to buy a tent, The other colleague I heard from is a female colleague of mine who was describing to me how glad she is that she does not have her own children right now, because she couldn't imagine being a mother under these circumstances and having to worry about whether or not I could feed my children or whether or not I could protect them from bombardment, knowing that I couldn't. She also sent me a very funny video of her brothers dancing and said something to the effect of, we can't be sad all the time, so I'm sharing this video with you. It was very funny, but just kind of reinforces this warmth and love for life, her trying to make me feel better when she's going through absolute hell. I've heard that consistently from so many doctors. We're literally living in hell, end quote.

That just comes up over and over again, or we feel like the whole world has abandoned us. And they try and describe the carnage. They're incredibly resilient people. And I say that cautiously because I think talking about their resilience or the fact that they're heroes also denies them the inevitable suffering that they're experiencing. And I think that they have no choice but to continue to be resilient, but to continue.

And one of my colleagues told me that a couple of days. I think her exact words were, I don't have the privilege. I don't have the privilege of not being strong right now. I don't have that privilege. I don't have that privilege for my family.

I just don't have that privilege. And she's like, sometimes she says, I'm broken inside, but they can't know. She went on to describe how she no longer experiences joy, how she feels like nothing matters anymore. And it's clear that this is affecting her psychologically. But at the end of the day, she feels like she doesn't have the privilege to even lean into that or receive support for it, because she has to continue to be strong for her patients and for her family.

So yeah, it's horrifically difficult. Most of them say that the most difficult thing, work-wise, is, well, two things. One, working with so little resources in the face of mass casualties that no healthcare system could accommodate anywhere in the world. And the other is the human suffering that they witness on a daily basis, particularly the children. And they just describe countless children that come in with no identifiable family.

And the children call out for their parents, and usually, usually they find out later that the parents were killed in the same bombing. Sometimes they find out that the parents were killed in a previous bombing and that the child had survived. And now the child comes in injured in a subsequent bombing. And it's just, I mean, it's heartbreaking.

But at one point they even ran out of morphine and ketamine. And so they could do nothing but hold these children's hands while they died. And I, like I, can't imagine. What are we, day 110, almost? I can't imagine doing that for a single patient, never mind a hundred and ten days of.

One hundred percent of the hospitals, in terms of access to life saving supplies needed, you know, that you need to stock these hospital with, one hundred percent of the hospitals. There are 36 hospitals in Gaza. In terms of the number that have been targeted as in directly bombed or sniped at or besieged, I'm not sure. I have to go back and look at our records. But several, I mean, I can name at least five while we're sitting here.

And when I say bombed, it's not that the whole hospital has been reduced to rubble the way that universities have. It's more that parts of the hospital get bombed. And, in many of the situations, patients and health care providers die when that happens, as happened at Al-Awda Hospital, where two MSF doctors were killed, two of our colleagues. And you may have seen the whiteboard where one of the MSF doctors had written. on.

there, you know, the surgical board where you write the cases and the times for all the cases. It had been wiped clean. They just couldn't keep up with all the cases. And he, he wrote something to the effect of, we did our best. Remember us.

We did our best. And he was killed. That whiteboard, there's footage that you can see from MSF about this. That whiteboard is was almost destroyed, but you can still see traces of what had been written before. And there's a photo of what had been written before.

And that doctor was killed. So I think 100 percent of hospitals have been targeted in one way or another to put them out of function. And then there are a number of them that have been targeted directly in terms of bombardment. There were several that were besieged, where doctors, nurses, patients were not allowed to move in and out of the hospital. They described being sniped at from the windows when they tried to walk past any of the windows.

So they would get on all fours and crawl to get from patient to patient. And because the hospital was besieged, they didn't have access to food or water or, for many of them, electricity inside those hospitals. And in terms of so that's kind of direct military targeting of those hospitals. But all 100 percent of those 36 hospitals were targeted in other ways, including, as you probably remember, in the early days, the cutting off electricity, water and then ultimately fuel, which resulted in the hospital sequentially unable to operate their ventilators, their dialysis machines, their sterilization machines or have any lighting for the facilities. And then, when communication gets cut, what that means is the hospitals cannot communicate with each other.

So for the last, however many days over a week now, for example, the one maternity hospital that's receiving the majority of pregnant women in Gaza is in the south. It's a tiny, tiny little hospital that's not constructed to handle that volume of patients. And they described not being able to reach out to any specialists anywhere because communication was cut off, or to any hospitals to see if they could transfer mothers. One mother in MSF described going to hospital and there being them not being able to accommodate her. And so she went home, delivered her baby in the latrine that was near her tent, and the baby didn't survive.

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Like whenever you hear about Palestinians, it's, you know, 66 Palestinian children died today, as if that's what Palestinian children do. And at the same time, you almost can't fathom what it means when you reflect on 10,000 kids and counting.

How do the folks on the ground make sense of that? I mean, is there a way to even make sense of that?

That figure in Gaza is over 100.

. We talk about mothers, 48 mothers on average killed per day. Mothers, two mothers an hour. That's two families left motherless every single hour in the time of this interview. And I think reflecting on those numbers is important because it demonstrates the scale, severity and speed at which this massacre has unfolded, in a way that I think is important.

And I think it's partly one of the many reasons that's prompting people to take this to international courts. Because it's that the numbers speak for themselves. Yeah. But there is a risk, as you said, if we are reducing things to numbers, there's a risk of desensitization. And there's a psychological phenomenon that I learned about recently, you know, that, essentially, your empathy decreases as the number increases.

So there's this reverse. And we see that we see a decreased interest from the media. We see a decreased interest of engagement globally as this becomes more and more catastrophic. The first point is the numbers themselves. And this has been, you know, a deep sense of frustration for many of us who know Gaza well, because that number is constantly cast into doubt.

There's a disclaimer that says this does not include those bodies that we were not unable to identify or those that are still trapped under the rubble. So it has to be a gross underestimate. And I am genuinely afraid to let my mind imagine what the actual death toll is going to be at the end of this. And then experts are also saying that the likely death toll from the living conditions, so starvation and disease, are likely to be at least as high when, you know, even once there's a ceasefire.

It's like you count the number of dead who are attributable specifically to a bomb or a sniper bullet. But sometimes we attribute those who are killed because of circumstance as a function of just a death number. that that's kind of happening rather than a function directly of destroyed infrastructure. Have your colleagues talked a bit about the growing number of infectious disease, illnesses that they're dealing with and the collapse of public health?

the entire time that they're there. Most of them come back still unwell. So absolutely. Like everybody is getting sick, mostly respiratory tract infections and diarrheal disease illness. And we've seen recently an uptick in hepatitis A as well.

We were talking yesterday with one of the organizations about the dire need for primary health care, exactly for that reason, that there's just everybody's so sick and they're seeing more and more cases of malnutrition. And, you know, children who are malnourished also have significantly compromised immune systems. So they're more likely to get sick, they're less likely to recover. And when they get sick, that kind of propels that vicious cycle of malnutrition and.

And the psychological toll is going to be profound. And you talked about the resilience of the folks in Gaza, but, you know, at some point there's no way to be resilient to watching your cousin die and your uncle die and your child die. Has there been infrastructure to try and deal with the catastrophic mental health consequences of this? And what would it take to try to do that? Obviously, make the violence stop, but, even beyond that, to provide the care that people.

There's a reason they're capable when it comes to mass casualties and managing trauma in general. And I hear this over and over again from non-Gazan colleagues who've gone there. It's because they've sadly had to do it so many times. But no, I don't think you can recover from this sort of trauma. The infrastructure was there, as it was for other types of illness and health issues, but it's been decimated.

I mean, the entire health care system in the Gaza Strip has been annihilated. I don't know what that means for the day after in terms of psychological support. In terms of psychological support right now, while this massacre is unfolding, some of the colleagues describe where they are from a mental health standpoint. But what a lot of them will say is, I cannot provide that kind of care for my children right now. They're hungry.

They need food. They need water. They need safety. And then we can talk about the psychological impact that this is having on both of us. And I think that's kind of what a lot of people, it's kind of, you know,

I think it's something that was extremely difficult, but consuming every aspect of your concentration and energy. And as soon as it's over and you reflect on it, you start to feel the actual weight of what you experienced or what you saw. I know that's happened to me with some of my previous missions. You're just so focused on surviving. And I think that's what they are experiencing right now and are going to need a lot of support when it's over.

What I can say, though, is, you know, and I'm always cautious to talk about resilience when someone is going through something that nobody can or should experience, is Palestinians in general have the sense of Samud, the sense of patience, resilience. that is really remarkable. And I think it comes from a lot of things. But family structure is very strong in Gaza. Faith is incredibly deep, profound amongst Gazans.

And I think those two things provide them with a support system and a way of thinking about things that really makes them more able to endure what I cannot fathom ever enduring. But yeah, I think certainly there's going to need to be a lot of psychological support under their terms when all of this, I hope, is over soon.

There's so many things that we can do. But the first and most urgent thing is to advocate for a ceasefire and to do that through every possible means that you have access to, you know, within your family, encouraging other people to do the same at your workplace, in the kind of mobilizations that are happening within your community, writing to your representatives. And this is kind of a bare minimum, calling your representatives. Then there are other people that, you know, take it a step further and are not as dedicated, you know, the majority of their day. And I don't know if you know Jewish Voice for Peace, for example.

I mean, there are individuals within that group who have not stopped for 100 days. And I think advocacy is incredibly important right now. So I would say certainly, advocacy. Don't grow despondent watching something on the news that you feel is out of your control. We all have power.

We just have to find it, channel it and be determined about it. And I think there are very few things in this world that make me more determined than watching a mass massacre of an entire civilian population happening before our eyes. There's an urgency to it. And I think let that urgency drive your action. And then, of course, there's donations and looking at ways of rebuilding Gaza and supporting Gazans as time goes by.

And I really want to stress that other second point, because I think, you know, the suffering of the Palestinian people did not start in 2023.

. It's been going on for over 75 years, as has, you know, 75 years of occupation, 15 years of siege in the Gaza Strip, multiple similar bombardments. And every time that there is something that shocks us, we wake up, we want to help. We're motivated for a few days or a week, or a couple of weeks, and then we forget about it and we get sucked into our lives. And I think just the two things that I would say people, really I encourage people to do is remember that you have power and use that power right now to advocate for this, to stop now, not tomorrow, not the day after now.

And then the second thing is make a promise to yourself that, once the horrific footage is stored somewhere and is no longer being live fed all over your social media and television, that you remember that this is a entire population whose hopes and dreams have been decimated and are going to need your support going forward. And, you know, you asked me, Abdul, about the psychological impact. And I just want to add one more thing. You know, I'm a pediatric intensive care doctor. I'm around children who are suffering, sadly, all too frequently, and they don't want to be in pain and they want the people they depend on, that they look to for security and safety, to be by their side, usually their parents.

And if they feel well enough, they don't want to be hungry. And children in Gaza are deprived of all three of those things. They're deprived of pain relief. They're deprived of food and they're deprived, for thousands of them, of their parents who've been killed. And the amount of support that these children are going to need going forward, the amount of global solidarity that we need to muster to make sure that these children are supported forever, that these widows are supported, that these men who've lost their entire family, their wife, their children, their grandparents, are supported.

I think we have a responsibility to do so, because we've let the Palestinians down for way, way too long. We can't continue to fail them. How do we prevent this from happening again? That's a very good question, because after World War II, you know, the world had a reckoning. We sat down, we made rules, we made laws.

We have the United Nations, the Security Council, international humanitarian law. And look where it got us. There is an exceptionalism that we should not accept, and that's unfolding right in front of our eyes as we speak. And we need to change the world order so that this doesn't happen again. Humanitarian law is international for a reason.

It's supposed to apply to everybody. It can't apply to people who live in certain parts of the world at certain parts of time and not apply to anyone else. And I think a lot of people have had an awakening in the last few months, recognizing, you know, seeing previous conflicts differently to previous wars differently, and realizing that there is an exceptionalism that we're no longer going to accept as a world order. And I think there's so many countries in the world that are emerging right now with strong, courageous positions, particularly in the global south. And that flip needs to happen.

And the thing about it is if we don't address violence against people we're told are less than or not human enough or who suffering, we ignore, it opens up the norm where that kind of violence can happen anywhere. And I just think it's it's so critical for folks to step out of the identity questions and ask the humanity questions that come back and clarify the identity questions, because any of us should look at any child and say that he could be my kid. And if we fail to do that, the consequences are profound. And we're seeing that in Gaza. And I worry that this is creating a, I hate to say it, a permission structure for the next authoritarian regime to do the next thing and say, look, when it was done to the Palestinians, nobody spoke up, nobody did anything.

So clearly, human life is cheap. And the entire premise of this podcast is that human life ought to be the most cherished thing we have. And I really just appreciate you making that the goal of your life's work, your commitment to the people of Gaza and advocacy on their behalf, and your general good heartedness. Thank you for taking the time. Our guest today was Dr.

Tania Haj Hassan. She is a physician, a pediatric intensivist with Doctors Without Borders. And she joined us to share her experience working in Gaza and her conversations with her colleagues out there. Thank you so much, Tania.

They've been loving their time in our noses, our throats and our lungs. The bad news, and I don't think I have to tell you all this. This has been a particularly bad year for infectious diseases, like a really bad. Right now, rates appear to be near their peaks, as bad as they're going to get, which is pretty bad. But the good news is that rates of COVID, RSV and flu all appear to be falling, which means that hopefully we can expect some relief here soon.

If you haven't been following, there's been a major row shaking up the academy over the veracity of academic publications, everything from a data manipulation scandal, which cost the former president of Stanford his job, to plagiarism allegations which cost the president of Harvard hers. Now we can add one more hallowed institution to the list. The Dana-Farber Cancer Institute announced that it will retract six and correct dozens of articles co-authored by top executives after analysis by a British-based academic watchdog found that they were rife with duplicated or manipulated data. This moment, it reflects the collision of three trends. The first is how easy technology has made it to analyze past publications for inaccuracies, particularly when it comes to duplications or plagiarism.

The second is that there's been a general academic inflation over the past several years, as the pressure to quote, publish or perish have loosened standards and allowed more mistakes or worse. The third and most dangerous is a general right wing effort to undermine the credibility of the academy by mining for these kinds of mistakes and then publicizing them broadly to shake trust in the expertise of those whom they target. I worry that a lot of good people are going to have their careers destroyed by this game of academic McCarthyism and that many of the bad faith right wing attacks will serve the exact purpose for which they've been deployed to make bona fide experts look like cheaters. And I do hope that this will drive a reckoning in the academic science community that improves the quality and rigor of published science. Against the veto of its Republican governor, Ohio's Republican dominated legislature has moved to ban all gender affirming surgeries and hormone therapies.

It restricts gender affirming health care for transgender folks until they turn 18.

. It also bans trans girls and women from girls and women's sports through college. So we discussed in a previous episode with Dr. Cullen Baker, gender affirming care that allows trans kids, their parents and their health care providers to make the best individual decision for them, protects them from suicide. It saves lives.

Point blank. And I shudder to think about what the implications will be for trans kids in Ohio. More broadly, the law is a massive incursion of government into people's personal lives and health care decisions. It's also a profound act of hypocrisy from an ideology, which is supposed to be about protecting people from government overreach, not doing it itself.

That's it for today. On your way out, don't forget to rate and review. It goes a long way. Also, if you love the show and want to rep us, do drop by the cricket store for some America dissected merch. and don't forget to follow us at Crooked Media and me at Abdul El-Sayed, no dash on I.G., TikTok and whatever Twitter's called these days.

America is a product of media. Our producer is Austin Fisher. Our associate producers are Tara Terpstra and Emil Frank. Charlotte Landis mixes and masters the show. Production support from Ari Schwartz.

Our theme song is by Takao Sazawa and Alex Uviera. Our executive producers are David Duran, Sarah Geismar and me, Dr. Abdul El-Sayed, your host. Thanks for listening.

The show is for general information and entertainment purposes only. It's not intended to provide specific health care or medical advice and should not be construed as providing health care or medical advice. Please consult your physicians with any questions related to your own health. The views expressed in this podcast reflect those of the host and his guests and not necessarily represent the views and opinions of Wayne County, Michigan, or its Department of Health, Human and Veteran Services.