Before the light goes out

“This is a struggle between the children of light and the children of darkness, between humanity and the law of the jungle,” tweeted Benjamin Netanyahu, the Prime Minister of Israel.

Let me tell you about our children and those who hold them.

One of them, a little boy no older than five, sits stunned at Al-Ahli Hospital after the ‘explosion.’ He says nothing when a man with a camera pats his head then shoulder and asks, ‘what happened, ammo?’ The boy just stares blankly–past the man, like he’s not registering the human contact. Then the boy, still looking away, opens his mouth to try to speak, and the words do not come out. ‘You were sleeping?’ the man with the camera offers, and the boy nods once, his eyes now aimed at the ground. Again, ‘what happened?’ And the boy’s eyes open big, he looks away, his mouth twists, he tries again to speak as his whole body erupts in tremor–a classic sign of shell shock. ‘You were sleeping?’ the man repeats, and the boy agrees with all he can manage, a nod and an mm, ‘and then the bombing started?’ Mm, the shaking now more visible. The space immediately below his left nostril glistens under the tent light. 

The boy sniffles, and now another man cups a gloved hand on the boy’s shoulder. This other man, who crouches to meet the small boy at eye level, asks if he’s scared, and again the boy nods, and the hand wraps around the boy and the boy looks distressed and his whole body is still shaking. ‘The bombing is over, the bombing is over,’ the man with gloves tells the boy as he pulls him into a hug. The gloved man kisses the boy’s forehead–tinted grey like death from the debris–and whispers words I don’t know the child’s body believes, ‘it’s okay, it’s okay, it’s over, we’re here with you.’ The video zooms out, and we appreciate the man with gloves wears scrubs and a stethoscope–it seems he’s a doctor. The boy gingerly rests his small hand, loose and gently folded, on the thigh of the doctor, and for whatever reason this breaks me. The way he hesitates to find comfort in this stranger, to fit into the space between the doctor’s arm and chest, ‘it’s okay, it’s okay,’ the doctor places his other hand, the one not holding the boy, on the boy’s chest, so narrow this average-sized adult hand covers it, ‘we’re here with you, okay?’ And the boy closes his eyes, and something gives, and he relaxes finally into fitful tears. And again, the doctor kisses the boy’s forehead.

‘Shell shock’ was first described during World War I by soldiers who, after time in combat, found it difficult to function; they experienced nightmares, tremors, confusion, tinnitus, mutism, and generalized impaired perception. Some doctors hypothesized the symptoms were ‘commotional,’ secondary to the brain rattling inside its bony encasing. Others said the basis for shell shock was not medical–localizable to the physical body–but rather psychosomatic. They suspected the symptoms were outward signs of a body trying to dissociate, struggling to keep consciousness of trauma at bay, a body sensing something was wrong when it was not–or rather, when it was over. The doctors treating these soldiers proposed recent advances in the lethal technologies of war had something to do with it. The doctors were unsure how to treat or prevent shell shock besides stopping the war, a measure outside their realm of power.

At Al-Ahli the boy faces chaos, surrounded by limbs separated from torsos from heads. He can see the dead bodies of children, some of whom surely he’d been playing with just earlier that day, new friends he’d made under circumstances children register differently than do those responsible for their safety. The day before the attack, a video shows kids at Al-Ahli outside, at what looks like a playground, holding hands in a circle, laughing conspiratorially at jokes. A baby breaks away from the hand-holding circle to run across the screen. In the same video—recorded by an artist who was killed by Israeli bombs—children reach into bushes around the hospital grounds, exercising their civic duties early, unbothered by the logic of entropy, collecting garbage into plastic bags as bombs rain down around them. There’s a slide, I imagine for the pediatric patients the hospital received before October 8, one these internally displaced children can enjoy. 

The boy’s family had brought him here, to Al-Ahli Hospital, founded in 1882 by missionaries decades before the British formally claimed Palestine theirs on the basis that the Europeans knew better than the natives what the land deserved. The hospital grounds are impressive—a whole communal infrastructure, including a church on site. Al-Ahli, I read, is the oldest hospital in Gaza—older than the Balfour Declaration and Theodore Herzl’s The Jewish State—among its most beautiful, and the boy, the child’s family, like the thousands of others who flocked there for refuge after being forced out of their homes—by bomb or bomb threat—hoped to be safe there. It was a hospital. 

The boy’s eyes, until he closes them to cry, show someone, a child, who has seen so much at once it has both hollowed him and saturated his receptors in ways he does not have the means to process, his pupils so big they seem almost to touch the eyes’ whites. Sympathetic nervous system on overdrive. This boy’s body is responding to violent death many magnitudes more than adds up to terror. Eventually, ‘shell shock’ was renamed ‘PTSD,’ what psychiatrists call ‘invisible’ trauma. Except the body wears it plainly, these signs of a person unable to make it stop, for themselves or for others. Is the boy at Al-Ahli too young to remember? How about the doctor, who at the end of the video stands to leave this delicate trembling life so that he can tend to others, does he forget? 

The video doesn’t say what happened to the boy’s parents. More than fifty Palestinian children are now the only surviving member of their families. It has become so common Palestinian doctors have coined for it a medical acronym: “W.C.N.S.F.=Wounded Child No Surviving Family[–]it’s a thing in Gaza.”

There is another child, a small boy maybe a couple of years older than the boy surrounded by death at Al-Ahli, who might also be at Al-Ahli, and whose brother, lying on a gurney or a table or some other flat surface, wears a shirt covered in fresh blood. The glazed-over eyes of the brother covered in blood suggest he’s close to a different world. The brother who is still in Gaza leans over the table and says, ‘repeat after me.’ He asks his dying brother to recite the shahada, words some believe a person must say in life to die a Muslim. He guides the brother who is leaving, who this child knows is leaving, through the words with patience, with the seriousness of someone seven times his age and five times his size. He brings his ear to his brother’s mouth, to make sure the words, barely audible, are spoken. He asks if his brother can speak up. He officiates his brother’s death, with a love so big his concern is that his brother should go where he deserves to. I almost forget he is a child, except his lower body dangles over the side of the table. I am watching this on my phone, a maturity and composure and self-sacrifice too big for a child who, at his developmental stage, American medicine teaches us has no conception of death, this boy who knows to name the death of children, ‘Israel.’ His attention does not waver; he sends his brother off, as sounds of distress gather around them. These boys can’t be more than two years apart, and I wonder when this boy born into the world’s most crippling siege lost his childhood. Feeling effective in the face of harm provides a transient barrier against psychiatric trauma. This boy intuits what to do without concern for or awareness of the self-benefits. Who else better than himself to do this for his younger brother? I’m not sure where the parents are.

There’s a child with a face caked in dust and dried blood, who gathers himself enough to ask the doctor treating him if he is going to live. To the viewer the boy looks okay, standing and breathing without open wounds, and the child’s unnecessary panic could be cute were this someplace else, did he not know death the way children in Gaza do.

There’s a girl in Gaza whose family moved after October 8. To Deir Al-Balah, I think she says. The Arabic news reporter asks her what happened and she can barely string together words. She doesn’t seem to comprehend she’s on live TV, or know what to do with the microphone floating in front of her. She doesn’t know where her family is, the reporter tells us. He asks her what she’d like to say to the people watching and is met with total blankness. The reporter asks again, and then he feeds her the suggestion, ‘would you like this to stop?’ And she looks at the man who’s just asked her the stupidest question in the world and says, ‘yes,’ and nothing else. A heavy silence follows. He addresses the camera, and she walks off to I’m not sure where.

The reporter then says, about the girl who has lost her family, ‘she is in total, total shock,’ and then the news screen returns to the news anchor seated in Beirut and the guests calling in remotely: a reporter at a protest in Iraq; a surgeon at the biggest hospital in Gaza; and a political analyst in an office I don’t catch where, wearing a suit, wiping his eyes with a tissue after seeing the state of the girl. The news anchor, visibly moved herself, points out that the analyst is crying. She asks him something political, for an analysis of the situation. His voice cracks as he says, first directly and then again in different ways, ‘it slices up the heart, what’s happening to our people in Gaza.’

The news anchor gives the floor to the surgeon in Gaza one last time to wrap up the hour. He is quiet, his eyes welled with tears, and the edges of his lips curved slightly. After some seconds, he reaches for the words of celebrated Iraqi poet Muthaffar al-Nawab, ithnaeyatu karbala’u? 

There is something destabilizing about witnessing a doctor express signs of distress or grief, however measured. The news anchor, who has registered the shifts in the surgeon’s expression, first mirrors it and then cannot withhold how he does: she says she doesn’t know what to say, to him and to the people, to our sisters and brothers in Gaza. She is with the children of Gaza. And then, because this isn’t enough, ‘God is with the children of Gaza.’

The Prime Minister of Israel deleted the tweet broadcasting genocidal intent after they bombed the hospital. Part of the ceiling of the operating room at Al-Ahli fell, the surgeon said. He moved toward the sound. He saw bodies of children ‘dead, not moving, and wounded’—the spectrum these doctors’ eyes have adjusted for. Several were amputated (by the bomb, not the doctors). He placed a tourniquet on the leg of a man who was bleeding, his leg blown out at the thigh. Gaza is running low on tourniquets—the Israelis targeted the Glia project facility, run by emergency medicine doctor Tarek Loubani, that manufactures them. The surgeon then found a patient with shrapnel in his neck. The surgeon waited for an ambulance, then escorted the patient to Al-Shifa, the hospital where the surgeon had been operating for every other day except this one, when the Israelis decided to target this hospital. He had come to Al-Ahli because the number of injured there had well-exceeded the available beds, and the hospital administration had asked for his help.

In a recorded press conference, the surgeon stands with other doctors amidst piles of dead people placed into body bags. Someone who sees the footage remarks on the dehumanization required to leave doctors with no choice but to place a podium at the scene of a massacre. When it is the surgeon’s turn to speak, first in English, his eyes carry something I can only describe as horror. Still, when he speaks, his voice does not shake or crack. The surgeon pronounces his name to accommodate the ears and tongues of non-Arabic speakers, replacing the Gh with a G, drawing the letters from the same shallow place the other English words will come. He tells the listener he is a volunteer with Médecins Sans Frontières, that he is British-Palestinian. 

In the colonial situation, a doctor’s self-restraint becomes an exercise in collective self-preservation; they must tend to their injured and sustain their people’s morale, on the ground and around the world. They bear witness to unspeakable horror, and they must find ways to make their own visceral responses secondary, so they can act. And, because doctors field a significant bulk of the international community’s humanitarian concerns, they withhold emotion, which is to say their full humanity, in conversation with Western reporters, to increase the possibility of human recognition. They perform the perfect rational actor. They stay cool, calm, almost numbed, as dead bodies pile up and the earth is cracked open to accommodate hundreds of bodies at once, mass graves because the tents and the ice cream trucks are full already, and the smell of death is everywhere. 

There are, of course, other doctors in Gaza, some of whom are still alive, few of whom are interviewed by Western reporters. This surgeon gained widespread media attention because he speaks English, because he is based in the United Kingdom, because, minus his slightly crooked glasses–more of a quirk that adds character than a flaw anyway–incredibly well put-together, because he has international prominence and speaks like a surgeon–with a tempo so measured and exact it demands attention, because his humanity for the Westerner is easier to follow.

Two days after the Al-Ahli Hospital massacre, the surgeon tweets, “my first surgery yesterday after I managed to pull myself together after the night before, was on a 5 year old girl who[se] mother and sister were killed. She had massive wounds in her arm. She looked so frail and so alone. How many times can your heart break.”

A statistic I keep hearing, to support demands for a ceasefire, as though adults don’t deserve to live: ‘nearly half of Gaza’s population of 2.3 million, is children.’ Do people understand why? The surgeon in Gaza tweets about a thirteen-year-old boy with full-thickness burns on his face and upper limbs: “his older brothers were trying to keep him calm by telling [him] that all he needed were some creams and he will be alright. He will not be alright” He ends the tweet like that, without punctuation. The words hang, harrowing. There are more typos in his tweets—whole words missing— in the days after the Al-Ahli massacre, than before.

As of October 25, at least 900 of the 1600 Palestinians still missing are children. Children’s bodies are small, and younger children–if they have words at all, if they are still alive–know fewer ways to call for help. All of this makes them harder to find. The Israelis have destroyed tens of thousands of homes–at least 45% of all housing units in Gaza–and hundreds of thousands of survivors flock to internationally declared safe spaces, like mosques, churches, medical facilities, United Nations compounds, seeking shelter. Al-Shifa Hospital, Gaza’s largest hospital and its medical epicenter, currently hosts some 45,000 internally displaced persons. Footage from around the hospital shows halls so crowded people all but spill out the windows; at night they sleep in rows outside near the trauma bay or scrunched up on cold hospital tiles, under fluorescent hospital lights that are set to go out as soon as fuel runs out. The number of active ambulances decreases as the fuel supply dwindles. The Health Ministry has sent out an urgent appeal, calling on Palestinians to spare whatever liters of diesel they are able, to stall a total shutdown of the healthcare infrastructure. 

The United Nations, in several statements issued by its various agencies since October 8, calls upon the relevant parties to allow humanitarian aid to enter Gaza. Gaza, it reports, is almost out of body bags. Imagine we lived in a world where instead of more body bags delivered through a ‘humanitarian corridor,’ the demand is that the occupying power stop killing people. Or, that Israel no longer had the power to carpet bomb civilians en masse with impunity. Elsewhere, the World Health Organization insists on doctors’ right to do their jobs, rather than condemn the party explicitly targeting medical infrastructure. After the Israelis gave Al-Awda Hospital two hours to evacuate on October 13, Médecins Sans Frontières tweeted, “our staff are still treating patients. We unequivocally condemn this action, the continued indiscriminate bloodshed and attacks on health care[sic] in Gaza.” A condemnation, even ‘in the strongest possible terms’ has no teeth, means or spine to do anything about it. On October 21, a twenty-truck convoy was finally allowed to enter Gaza, carrying some 44,000 bottles of drinking water provided by UNICEF, enough to last 22,000 people for a single day. Gaza has over two million inhabitants. The request is for more water bottles, not that Israel restore Palestinians’ electricity and water, or Israel no longer have the power to deny the people it occupies their basic needs. As of October 24, 64 aid trucks–136 trucks short of what Gaza, under the decades-long blockade, required at minimum every single day before October 8–have been allowed entry. None of the trucks contained fuel. One was full of coffins.

Hospitals are not safe. On October 13, Israel targeted Al-Durrah Children’s Hospital with white phosphorus, a chemical that catches fire as soon as it is exposed to oxygen, reaching temperatures of up to 1,500 degrees Fahrenheit—hot enough to melt aluminum—burning through skin and even bone until it is washed off, while the water in Gaza is in short supply. The hospital was forced to evacuate. To date, 35 healthcare facilities, 20 of them hospitals, have been damaged by Israeli missiles. Al-Quds Hospital hosts 400 patients, many of whom are non-ambulatory, and over 12,000 people seeking refuge. Israel has demanded its evacuation. Hospitals not yet targeted are encircled by missile fire that seems to close in by the day—intense Israeli bombing in the immediate vicinity of Al-Shifa on October 25 caused the walls to shake. Danny Yatom, former head of the Mossad, said during an interview with Israeli TV on October 15,  that “Al-Shifa Hospital in Gaza must be absolutely destroyed, wiped off the map whether there are civilians or not.” Former Israeli Prime Minister Ehud Barak, in an interview with BBC on October 19, reiterated this commitment to its destruction. 24 ambulances have been targeted and 34 paramedics killed, mostly en route or upon arrival to the scene of targeted homes. The logic of elimination: the colonizer destroys the medical infrastructure to diminish a people’s ability to live, after they try and cannot crush the people’s will.

Those killing us would rather we go without friction. Mostly, Western media mourns Palestinian death as the unfortunate consequence of Israeli self-defense. At best, these deaths are ‘senseless,’ language that garbles what is crystal clear—as evidenced by both current rhetoric and history: Zionism sustains itself by killing Palestinians. (Think of how they start wars to win elections. Think of how their politicians describe us as ‘demographic threats’ and ‘human animals.’)

In the sterile field of medicine, even the articulation of culpability (let alone expressing a political position) amounts to contamination. After an Israeli airstrike targeted the home of Palestinian doctor Dr. Mohammad Dabbour, killing him and members of his family, the American University of Beirut’s Global Health Institute tweeted their condolences without mentioning who killed him, or that he was killed at all. They mourned his ‘passing’ with ‘profound sadness,’ grief without anger, making no demands that anything should change–symptom management in place of root cause analysis or prevention. (They later replaced the tweet with one that read he was “killed by an airstrike,” again without saying by whom.) The American College of Surgeons issued a statement early last week, about “the horrific situation unfolding in the Middle East.” They use neither the word ‘Palestine’ nor ‘Gaza,’ nor give cause to any of the horror, just assurances about “close contact” with surgeons “on the ground” and “marshaling resources to assist those affected by this humanitarian crisis.” Which ground, or how the resources gathered would arrive—were the intention to give them to a totally besieged people rather than their occupier—remains to be known. In a sense, these surgeons approach “the situation” as they might an operation–under ideal circumstances, the body is prepped and draped such that nothing is visible to the eye except the operative field. This keeps things neat and clean. In Gaza, they are out of surgical prep, and there is no time for adequate draping–the patient’s entire body is exposed, at once, on a bed at the edge of a hallway, and the medical team isn’t waiting on a lab result or forensics report; they know what happened, who dropped the bomb on this child’s home in the middle of the night.

It matters to those who are killed, to get right who kills us. It is obvious, if you believe in history and data over the world’s greatest coincidences and poorly made audio-files, who bombed the Al-Ahli Hospital. The Israelis had issued warnings to the Anglican Church demanding that Al-Ahli be evacuated, and the doctors stood their ground on behalf of patients who could not evacuate, and because there’s no legal or moral basis for an occupying power to evacuate a hospital, no ethical basis for what they sought to do to the infrastructure after it was emptied of life. “It was the most broadcasted war crime in history,” the surgeon in Gaza who survived the attack said to the Lebanese news anchor. What about reports saying there weren’t large craters, or the damage pattern you might expect? The anchor pushed back. Surgeons speak with sometimes disarming directness: he responded it was well-documented–and it is–that the Israelis and the Americans use Gaza as a weapons testing lab, and to advertise these exports. (Doctors in Gaza are reporting horrific burn patterns “down to the bone,” unlike anything they’ve seen before.) The magnitude of the damage done to the hospital, the long, long history–dating back to at least 1982, when the Israelis bombed a children’s hospital inside a Palestinian refugee camp to inaugurate their invasion of Beirut–of targeting hospitals, and, most importantly, the fact they said they would do it, means they did it. That Western media welcomed the multiple contradicting Israeli explanations as they fumbled into their laps–and that both the Israelis and the Americans refused to release satellite imagery over one of the most highly surveilled pieces of land in the world–are consistent with the historical pattern, too. 

The colonizer exacts harm along the body: it counts calories, limits access to basic medications and life-saving treatments, targets those who can provide them, takes away food and water–all to subjugate the colonized into submission. The colonized recognize the meticulous weaponization of their mortality. A mother in Gaza, upon hearing of her children’s death, breaks down, screams through the hospital courtyard; her children died before they were able to eat. 

The colonized doctor, who offers their person as a sort of channel between their people and Western audiences, notes the ubiquitous commitment to systematic erasure and, to avoid censorship, learns to run their own perception through a sieve: they grant us permission to report on the humanitarian toll, and we are up to the task. The colonized doctor enumerates the harms against the body: the surgeon in Gaza shares that doctors are using vinegar to treat pseudomonas, a bacterium to which trauma and burn wounds are exceedingly susceptible, especially without proper irrigation. They’ve run out of burns dressings. They can’t adequately sterilize surgical equipment; the water pressure–because there’s no electricity or fuel–is too low to run the autoclaves. They use soap and water to sterilize operative fields; they are out of chlorhexidine. They are performing procedures without local anesthesia, operating in the corridors and halls of the operative floor, then transferring patients to whichever corner of the place is empty, for recovery. 

After describing the shortage of medical supplies to a Western reporter, the surgeon in Gaza adds, “there have been 24 doctors killed, 14 nurses killed, and a lot of my colleagues have had families killed or have lost their homes. And so, not only have the consumables and the medication needed to treat patients been depleted, the human resources–the people who run the hospital, the doctors and the nurses–have also become depleted.” 

The colonized doctor deals in statistics. Even to narrativize these deaths is ‘dangerous’–context leads to feeling, and feeling compromises ‘objectivity.’ The surgeon in Gaza speaks about his colleagues–who have lost loved ones and still return to work to tend to the loved ones of others, and whom he no doubt loves like brothers and sisters–like this to Western reporters because if he does not, he risks being seen as irrational, compromised by emotions like the other members of his kind. His are people who often lack the ‘discipline’ to maintain their composure when confronted with those promoting or enacting their people’s extermination–those on the side of the Israeli Prime Minister’s humanity. 

“Science depoliticized, science in the service of man, is often non-existent in the colonies,” Frantz Fanon writes in A Dying Colonialism. As doctors, and as people, we are obligated to choose the side of life. A doctor, because they receive the wounded and the dead and their families, can speak to the suffering of a people struggling to live, without losing the texture or sacredness of each individual life they tend to, with their hands and whole selves. They viscerally understand the weight of what is unfolding. Back at Al-Shifa Hospital a few days after the massacre at Al-Ahli, the surgeon tweets, “the layers of tragedy in this genocidal war. The plight of wounded children and adults with learning difficulties and the plight of their families.” Very early on in a doctor’s medical training, they are only a ‘reporter’—they present the facts; they do not yet have the tools to interpret the data. In conversations with Western journalists, the colonized doctor is denied graduation. They are permitted to offer medical information confined to burn wounds and body bags, to the narrowest interpretation of the human body, blind to the world that unravels it. The colonized doctor fields all of these layers of human suffering, and they have the requisite skills to put these in their proper order. Instead, they are expected to hand the pieces over to someone else, someone somehow more qualified than the people living it, to string them together into particular political valances. The colonized might hope in return that their suffering leads to human recognition. The conversation stalls past that.

A people’s doctor does not aim to humanize. A people’s doctor draws their strength and moral clarity from a place where dignity is inherent, where they and their people are deserving of life already. These doctors do this not to ask for their lives’ grievability, or that their people be seen as deserving of water and medicine. They are doctors–their job, with the evidence at hand, is to diagnose. “We are facing a killing machine masquerading as a state,” the surgeon in Gaza tweeted days before the attack on Al-Ahli Hospital.

On the Arabic news segment with the analysts and the reporter in Iraq and the Lebanese anchor the day after the Al-Ahli massacre, the surgeon speaks differently–there is an openness, like he can start from a place of human-already, like he trusts his audience to bear witness to the horror with the gravity and humanity his people deserve. He rattles off the same statistics: he shares that infections are spreading for salvageable injuries because of the operative backlog, such that they’re having to amputate limbs en masse, even for children. At the same time, he does less to hide that the words in his medical toolbox feel inadequate. Here, he is a person, and medicine is a tool among others, through which he supports his people. When the medical terms are not enough, he reaches for historical comparisons, and his audience draws from the same historical well: what is happening in Gaza, he says, reminds him of the Israeli siege of Beirut in 1982, and of the first Qana massacre (there were two), in 1996. It is apparent, listening to him speak with people who are of him and then with people disinclined to recognize him as such, how much energy the dehumanization siphons away from discussing the situation on the ground in a way that might add up to anything beyond the opening of a humanitarian corridor.

In another tweet, after the attack, the surgeon in Gaza quotes James Baldwin, “For nothing is fixed, forever and forever and forever, it is not fixed; the earth is always shifting, the light is always changing, the sea does not cease to grind down rock. Generations do not cease to be born, and we are responsible to them because we are the only witnesses they have. The sea rises, the sea falls, lovers cling to each other, and children cling to us. The moment we cease to hold each other, the moment we break faith with one another, the sea engulfs us and the light goes out.”

Before the light goes out, there is still time.

The morning after the Israelis bombed Al-Ahli Hospital, the surgeon in Gaza tweets, “back operating today. They will not break us.”