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War & peace

12 February 2024

11 min read

Eye witness: life and death in Gaza’s European Hospital

Returning plastic surgeon Tim Goodacre reports on the struggles, the despair and the dignity of the people and the medics of Gaza during their long nightmare.

Graham Tomlin

Graham is the Director of the Centre for Cultural Witness and a former Bishop of Kensington.

Medical staff stand beside a bed in which a man lies with an amputated leg.

Medics confer about a patient in Gaza's European Hospital.

Tim Goodacre

Tim Goodacre is a vastly experienced plastic surgeon who recently spent two weeks in a hospital in Khan Younis treating the extensive injuries of the people of Gaza. I caught up with him to ask about his experience there.

Graham: Let me start by asking what was it like getting into Gaza? What was the process and how difficult was it to actually get in in the first place?

Tim: We went in as an emergency medical team under the under the auspices of the World Health Organisation, which is coordinated with UN OCHR. It was easy obviously to get to Cairo. Then we joined a convoy, a group of cars convening in the small hours of the morning in Cairo and then being escorted across the Sinai desert. We got to the border in time for dusk. What was staggering at that stage was seeing the number of lorries lined up, waiting on the Egyptian side to get in. They were two deep on one side, one deep on the other with a thin passageway through which we could drive through for mile after mile after mile of these lorries.

Was this humanitarian aid sent from other nations?

Absolutely. It was aid labelled from different countries or agencies. Crossing Rafah the next morning was all pretty haphazard and chaotic, but we met our driver on the other side. We then had to travel to Khan Yunis on the coast road because it was the safest part of the south Gaza strip. We went through a route called the Philadelphia Road, which is a gap between the two borders. As we drove along, we immediately were jumped on by some young lads who had put razor wire across the road. We picked up two of them who hung onto the car each side, with our window s firmly shut. As we sped along, they were our ‘protectors’, taking a pitiful sum to ensure that we would not be stopped at further razor wire and our vehicle plundered. It was our first experience of the lawlessness that's inherent at the moment in Gaza.

All along that side of the road there were people putting up new tents after a recent further mass displacement, as far as the eye could see. It made a huge impact on me - the devastating plight of the people who were there. It looked like those pictures of Glastonbury or Woodstock, where as far as you could see, the rolling fields or sand dunes or whatever were totally covered in makeshift dwellings. It was pretty cold and windy. And subsequently, while we were there, it rained an awful lot and your heart just went out to these people.

So these were people living in tents and temporary shelters?

Well, not really. They're barely tents. They're just finding flimsy bits of wood, putting them up and nailing them together. And these are not just the very poorest of the poor. This is everybody. Many of them were people from very well-to-do houses whose families have been displaced. I've worked in many parts of the world where there's poverty, but I’ve never seen so many people displaced.

One of the things that's remarkable however is the relative cleanliness, the desire to maintain dignity in the most appalling circumstances. But a young lad who’s now a young doctor (who I have worked with for a decade now) came to see me and he was the most dejected person I've ever met. He said to me ‘they've taken away my dignity’. The abject pain in his face was something that I won't forget.

You’ve been to Gaza many times before. What was different about this time? And you've seen it in the aftermath of previous wars and conflicts. What was what was particularly different this time?

It's utterly different – it’s the displaced population with nowhere to go and seeking shelter. When I first went in 2014 after Operation Protective Edge, I was taken to a huge neighbourhood of northeast Gaza, which had been flattened and at the time the impact on me was extraordinary. When I’ve visited subsequently over the last decade, they will show you this bombed out building and that flattened area, but I've never seen such vast numbers of displaced people. On the second day we moved into the European Gaza Hospital (EGH), which is where we were going to stay for the two weeks we were there. Inching slowly along amidst endless hordes of people walking around, seeing the dejection, despair, the hopelessness with nowhere to go - this for me is what defines this whole episode and makes it very different from others. This is in no way a diminution of other conflicts and human tragedies, but when there was bombing in Baghdad or in Kiev and Ukraine, people might go into underground shelters - there are places they can perhaps go to escape. Even in massacres such as in Darfur or Congo, there are places to run to. There is nothing like that in Gaza.

Was there a pattern to the kind of medical emergencies and wounds that you were having to deal with?

The vast majority of injuries were the impact of high explosives, so we naturally saw quite a lot of burns, although the majority of severe burns alone were being managed by the Red Cross team also at EGH. Some of them were people who had been crushed and pulled out of buildings which had collapsed. But that was that was the minority. The majority of our cases were direct results of bomb blasts. Every time you hear a bomb, somebody is being killed, yet many others are caught on the fringe of that. Shrapnel travels at astronomical speeds and hits people in in a completely random way. These injuries are devastating. There were scores of people coming in with limbs missing. Seeing somebody with a leg off at the thigh, a leg off below the knee, an arm ripped off was all too common. It was hard to take in - you have to become somewhat immune to the backstory behind each dreadful injury, and concentrate on the carnage in front of you, to be able to deal with the constant onslaught of cases.

How were the medics coping with it? You were there for two weeks. They are there for months, presumably on end?

I think it's incredibly important that we don't focus on the visiting medics. I usually peeled off at about 9pm or so in the evening - I had to go to bed and had to have a rest, but there were people trying to work through the night. What I want to focus on is the local people, particularly a young colleague, Ahmed, who was 36 years-old. He was statesmanlike in his ability to pull things together. His family are actually mostly in Dublin as they've got Irish passports. I cannot tell you how much admiration I have for that young Gazan man who shared his room with me.

He has been managing to create a team who work alongside him, since many of the staff who had worked at the hospital before (some of whom we had trained over several years in limb reconstruction) were not there. That is because they might not be alive, or having to support their displaced families, or simply are afraid to travel in daily to the hospital, or whatever. It is a huge demand on individual doctors to leave a family group (who invariably try to stay together, so that if they are bombed, they all die together and do not have to be a sole survivor.) to then work away from such possible loss of all their family members. It's an incredible sacrifice to be working in medical care when your family are all huddled together in a place where they may all lose their life, and that gets to them in the end.

The orthopaedic side is almost on its knees. Most of the system in the hospital is utterly on its knees. There were early years medical students who had been taught quickly how to manage wounds and to skin graft. They haven't got any pay, but some people have given a little money to my colleague’s account to try and give them some support. There were IT students and all sorts of others pulling together. How people can work in in such adversity and make things happen is quite a testament to the to the strength of humanity.

It all begins to play on your mind, and you start thinking is there another one coming? And you get no warning when the attacks are unleashed.

What was it like living under the bombardment, which was presumably pretty constant during your time there?

There may have been the odd period of four or five hours when there was no sound of close bombardment at all, although during that time there was probably small arms fire going on somewhere. But otherwise, it was relentless. One became somewhat used to the bombs in the distance, but when they're close by… Every time one of these bombs goes off, there are people dying. And that really that played on your mind. So huge numbers were seeking shelter anywhere in the vicinity of the hospital. If you can imagine a hospital corridor where every route is full of makeshift shelters, and you just go up around a stairwell and on the corner of each stair, there will be a family which will be hanging drapes up, trying to find some sort of privacy and dignity among the utter destitution.

I found it very difficult to sleep during those times. The hospital is in a quadrant, a square. On one corner there was a supermarket which latterly was hit by an F16 delivered weapon. You could hear the sound of the rocket go off alongside the scream of the low flying fighter jet, and the whole building shook. There's also the incessant sound of drones. It all begins to play on your mind, and you start thinking is there another one coming? And you get no warning when the attacks are unleashed.

It made me realise what soldiers undergo when they get what used to be called shell shock. There, even if you're not injured yourself, this constant shocking damage gets to you. I knew we had the knowledge that after a short time, we would be getting out - but it made me realise how tough Ahmed and others working there have to be. It will be having a devastating impact on the population, and for a nation.

I imagine the psychological effects of that are going to last for a long time in the lives of these people. You don't get over that quickly. If you live with that level of tension, thinking any moment now, I could die, that must stay with you and the marks of that stay for a long time.

I'm sure that's true. I'm not an expert in PTSD and things like that. Ahmed is a Muslim and said to me more than once that when you believe in an afterlife, you believe that your time will come at some point, and you accept that. We don't know when it is or where it is, but it will come. I have frequently wondered whether any of the fighter jet pilots have ever experienced themselves what it’s like to be underneath the impact of one of their weapons? Having felt somewhat what it is like to be on the other side of such an onslaught, I do wonder whether very many of those involved in ordering conflict really have any kind of understanding of what devastation feels like, when there is nowhere to run? I fear for what this conflict does to the humanity of both sides.

I genuinely don't feel brave, I don't. I'm not the kind of person who sees lights in the sky, but I know it was God’s calling to go there. It was simply the right thing,

Did you see any sign of hope or anything that gave you a sense of the way out of this?

The sense of hope is within the people who are there. There are many people who say they still really don't want to leave. They feel this passionately. It's their land. They do want to see a new Gaza. I tried to be somebody who lifted spirits. Communities can be rebuilt and there may be a new future which will come from the dust. I've been in touch with people in my University Medical school in Oxford to see whether we can do something about getting these young people's education continued.

You can imagine there wasn’t a lot of laughter in the whole environment, but on the few occasions when I did gather together with my colleague’s small group of young students and volunteers, usually late into the night, we would eat whatever food goodies they had to hand, and their sense of fun would burst out. Together there was a very strong sense of community amongst them.

How did your Christian faith inform the way you interacted with the situation? How did your Christian faith help you process what you were seeing and experiencing there?

I must say it was a deeply spiritual time for me. It was absolutely powerful to me to know that God cares and loves each and every one of these people. I longed to organise a football game with the kids. I was told that they had tried to do that, and it had become too dangerous. So there seemed to be no organisation around looking after the well-being of the children, their education, or the deeper impact on them of this war. People were jammed into the hospital, obviously because it was seen as a safe space, and it was humbling to think that us (as foreign workers) being there made them feel somewhat safer. It humbled me immensely.

I felt nothing but a sense of privilege in being a witness to all this. I was reading the Psalms regularly in daily prayer. There's also something about that land being the place where God himself suffered in Christ and went through his own agony, and that the Holy Family escaped through Gaza to Egypt.

I genuinely don't feel brave, I don't. I'm not the kind of person who sees lights in the sky, but I know it was God’s calling to go there. It was simply the right thing, a privilege and an honour to have such access which comes with having my particular background of skills and past history with Gaza. God is over all these matters, and we are compelled to respond.

Tim Goodacre is a Reconstructive Plastic Surgeon based in Oxford, with extensive experience of working in diverse environments outside the UK. He is immediate past Vice President of the Royal College of Surgeons of England.

Article

Comment

Politics

Virtues

27 September 2024

8 min read

The emerging frontier: renewing courage in geopolitics

Narcissistic moralising needs to stop, and we can learn from Churchill too.

Emerson Csorba and Gal Treger

Emerson writes on geopolitics. Gal is a tech investor.

Military personnel, wearing camoflague uniform crowd round a computer monitor.

U.S. Space Force guardians assess a threat.

U.S. Space Force.

In August 1939, the Polish poet Kazimierz Wierzyński reflected on a “Peaceful bliss which had become Europe’s chloroform.” Yet, then as now, crises shake us from moments of calm, especially when we abandon vigilance. We let our guards down, nonchalance replacing serious deliberation toward action.

A shroud of darkness has descended on the world over recent years, with new conflicts emerging just as – or perhaps because – democratic populations turn inward. These conflicts – whether the Russia-Ukraine War, the Israel-Gaza War, or the US-UK led battles in the Red Sea – demonstrate the courage of peoples sacrificing for their nations, families, histories, and traditions.

Yet, in much of the political West, narcissism – rather than courage – has become the focal point of our culture.

Christopher Lasch describes this narcissism in The Culture of Narcissism: American Life in an Age of Diminishing Expectations as a conceit of the present. Lasch notes that we have become a consumer society focused on individual self-absorption that leads to present-focus, sense of isolation, and disconnection from history.

The psychoanalyst Erich Fromm argues in The Heart of Man: Its Genius for Good and Evil that narcissism is an attachment to “self-image,” which “distorts rational judgment.” Yet, Fromm later reflects “If the feeling which the Greek poet expressed in Antigone’s words, ‘There is nothing more wonderful than man,’ could become an experience shared by all, certainly a great step forward would have been taken.”

This wonder of man is in the freedom to act in a world that is yet to be determined.

This is a position of “deep faith.” It encourages full participation in the world, affirming the self through action, though always in relation to something much greater.

The philosopher and theologian Paul Tillich similarly states “this is just what participation means: being a part of something from which one is, at the same time, separate. Literally, participation means ‘taking part,’ in the sense of ‘sharing’ or ‘having in common.’” We play, as legendary Notre Dame football coach Knute Rockne once said, "For everyone that came before us, and everyone that will come after us."

If common history is needed as our foundation for current action in geopolitics, to what then might we turn?

We propose a refocusing and modern renewal of alliances underpinned by Winston Churchill’s A History of the English-Speaking Peoples, a project he initiated in the early 1930s as the threats of Nazism and Fascism had taken centre stage.

This refocusing reprioritises courage in geopolitics, maintaining the light amid descending darkness. It is badly needed given the modern tendency to look inward rather than to sources of value outside of the self.

This is a pathway to vigilance in anticipation of the thief in the night, who may arrive at an unexpected hour.

Churchill – recently demonised by influential conspiracy theorists – emphasises the common cultural and political heritage of the English-Speaking Peoples, including the rule of law, individual rights and parliamentary democracy, which shaped the modern world.

Churchill reminds us of the global influence of English-Speaking Peoples in spreading democratic ideals and governance structures across the world, believing that the global spread of these ideas was instrumental in shaping modern life. He underscores the unity of the English-Speaking Peoples in facing global challenges, particularly in the context of the World War he foresaw. And he viewed the cooperation between the UK, the US, and other Allied nations as crucial to the survival of freedom and democracy.

It is important, now as much as ever, that we remind ourselves of Churchill’s wise words, building on them to address with courage the challenges of our present times.

Specifically, we must adapt Churchill’s emphasis on the English-Speaking Peoples to a focus on nations working at the frontiers of Western civilisation to resist rising darkness which seeks to corrupt the good. Ones not necessarily actually speaking English too.

Building on these unique and complementary strengths, these agile nations united as upholders of the values of English-Speaking Peoples should reindustrialize, rearm, redraft and recommit to a common goal in a world of increasing geopolitical conflict.

The sharing of expertise and overall close collaboration between these agile nations can facilitate rapid preparation for conflict at any moment, proactively addressing Wierzyński's dangerous “peaceful bliss.”

In other words, this is a pathway to vigilance in anticipation of the thief in the night, who may arrive at an unexpected hour.

Renewed partnership is necessary between these nations. There is a need for these nations to re-assert their historical courage, underpinned by vital modern capabilities.

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Alongside the United States as the focal point, these nations are Canada on the Arctic frontier; the United Kingdom as a Northern frontier; Poland as the Eastern frontier; Israel as the Southeastern frontier towards the Eurasian landmass, and Australia, with its recent experiences confronting neighbour China, on the Far East frontier.

Each of these nations serves as a regional center of power and influence: Canada in the Arctic and Atlantic; the US into the Caribbean and broader Latin America; Israel in the Middle East with the Abraham Accords and North Africa; Poland into Central and Eastern Europe, and Australia in the Indo-Pacific. Each of these nations possesses vital agility, given their small geographical sizes or populations.

These frontier nations respond to United States CIA Director William Burns’ 2023 Ditchley Lecture, in which he focused on “[hedging middle power countries who] see little benefit and lots of risk in monogamous geopolitical relationships. Instead, we’re likely to see more countries pursue more open relationships than we were accustomed to over several post-Cold War decades of unipolarity.” The focus here is courage with a long-term view, building a frontier-focused alliance rather than seeking relations based on short-term material interest only.

In this frontier model, it is currently Israel demonstrating the courage to uphold the values captured in Churchill’s account of the English-Speaking Peoples. Hamas’ brutal October 7th attack was predicated on the notion that over the last decades, Israel transformed into a consumer society, focused on short-term economic incentives and leisure pursuits. Israel provides technology and experience in fighting modern wars of various types, as well as persistence and proactiveness that other nations must quickly recover.

Canada is historically a frontier nation of courage, reflected for instance in its contributions to WWI and WWII victories, as well as in the often-quiet contributions that Canadians make to peacekeeping efforts across the globe. But Canada can take bolder action, given its strategic Northern location and proximity to the Arctic, with its vast natural resources including critical minerals supply and its vast freshwater reserves. It can become a more influential global player amid trade wars, helping reduce dependence on Chinese resources.

The United Kingdom’s combination of common law, property rights, financial markets and freedom of the press are important strengths. As Nigel Biggar finds in his Colonialism: A Moral Reckoning, the UK has historically championed free markets generating economic opportunities for diverse peoples; established peace where internal strife previously existed, protected the rural poor from wicked landlords, and provided civil service and judiciary systems to reduce corruption.

Poland, as noted by Radoslaw Sikorski in a recent speech, shares with the United Kingdom “the same strategic vision. It is based on the fundamental assumption that international law is the guardian of peace and stability.” Poland also “consistently supports close, comprehensive cooperation between the UK and the EU’s security and defence frameworks” with continued focus on strengthening its military capabilities. And, of course, Poland is keenly aware of the threat of war which which is ever-present on its border.

Australia has, over the last decade, demonstrated evident success in facing the threat of China on its doorstep, this ever-present threat producing a group of leaders across government, private and media sectors that are as sharp, worldly and realist in nature as any in the Commonwealth.

Renewed partnership is necessary between these nations. There is a need for these nations to re-assert their historical courage, underpinned by vital modern capabilities. C.S. Lewis, in his famous Screwtape Letters, shows that “courage is not simply one of the virtues, but the form of every virtue at the testing point, which means, at the point of highest reality.” Each of these frontier nations has historically demonstrated success in the face of testing.

Our focus cannot be narcissistic moralising – too often the case in today’s geopolitics – which is the product of the serpent’s advice in the Garden of Eden, in which our eyes will be opened as we “become as gods knowing good and evil.” We must not allow others to twist our sense of history, such that we begin to exalt ourselves in the present moment rather than adopting attitudes of service, sacrifice and worship of that which is unfathomably greater and farther-reaching.

Instead, it must be – as we have seen with Churchill, and as described by Dietrich Bonhoeffer in his incredible commentary on the story of the Garden of Eden, to act.

As Bonhoeffer writes, “If the Holy Scripture insists with such great urgency on doing, that is because it wishes to take away from man every possibility of self-justification before God on the basis of his own knowledge of good and evil… The error of the Pharisees, therefore, did not lie in their extremely strict insistence on the necessity for action, but rather in their failure to act. ‘They say, and do not do it.’”

The frontier model we propose facilitates such action, prepared with the necessary capabilities and coordination for the considerable challenges before us.

We must remember that to participate in the world with deep faith – courage – has been and always will be the basis for human freedom.

Indeed, this is the task of the nations: united by the common heritage of English-Speaking Peoples, acting with faith in the good, always at the frontier.