Article
Comment
Gaza
Middle East
5 min read

The human cost of the Israel-Gaza war

A veteran volunteer surgeon laments a well lived life.

Tim Goodacre is a reconstructive plastic surgeon, and volunteer at a hospital in Gaza.

A young doctor wearing scrubs smiles.
AbdulRahman at work.
Tim Goodacre.

The Israel-Gaza war rages on. Every few days a new tragedy hits our dulled senses. The West Bank and now Lebanon are getting dragged into the conflict. Palestinians and hostages continue to die, and hunger and disease threaten Gaza's displaced people as autumn and winter approach. 

Yet what is often lost is the human face of this conflict. This is the story of one such life. 

AbdulRahman was an intelligent, gentle and diligent young third year medical student in his early twenties, with judgement well beyond his peers. Towards the end of 2023, as the war spread more viciously towards southern Gaza, he was one a group of around 10 students who volunteered to join the team of health care workers at the European Gaza Hospital (EGH). I was volunteering there as a reconstructive plastic surgeon and and met him in the hospital.

Both medical schools in Gaza before the war began were in the north alongside their parent universities. They had been destroyed during the onslaught in the early months of fighting. In the southern town of Khan Younis, the EGH was the sole surviving operational facility to which the wounded could be transferred. It was overwhelmed by the vast numbers of families also taking refuge in what was deemed a safer space than most of the surrounding war zone.  

Many of the senior medical staff and surgeons had retreated to scattered parts of the strip, displaced frequently by the ever-moving conflict and driven by the need to support their families and stay together. ‘Live together-die together’ is an understandable feature in the horror show of war. Students, frequently left with no money or resources, started to volunteer to serve in hospitals in exchange for a little food and a sense of worth in the work they could offer. Any functioning hospital, if briefly ‘deconflicted’ so they could provide relatively safe care, found itself staffed by a disparate crew of local staff, displaced students, and an indeterminate number of more senior surgeons from both Gaza and humanitarian agencies. 

His desire to learn all that could be learnt, and to try to become the best surgeon possible, was palpable.

It was into this chaotic mix that young AbdulRahman walked having fled his family home in the east of Khan Younis in November 2023. A bright young man, with great aspirations to qualify as a surgeon and serve his community, he had spent the first six weeks of the war at home, unable to attend his medical school in Gaza City to the north, but working hard at his studies regardless, using every online and library resource available to him.  

At some point in late November, the battle zone moved south, and his family home was shelled along with many dwellings in the vicinity. Caught in crossfire, he sheltered in his neighbouring relative’s house after his parents and other close family had escaped to Rafah. 

Abdulrahman told me the dramatic story of his escape into the house in which he survived for a week alongside his relative’s family when I spoke to him in late January 2024. This young man not only survived an ordeal of indescribable fear and potential slaughter, but he was then arrested and interrogated in brutal fashion by IDF forces.  

On his release after a harrowing week, he made his way barefoot to the nearest hospital, which happened to be the EGH. In that place of safety, he was given food and water and after recuperation, volunteered to work alongside a reconstructive plastic and burns surgeon who had recently returned to Gaza after training in the UK. 

Although his family were still all alive in Rafah in displaced makeshift shelters, he opted to stay and throw his weight into whatever he could do to support the hospital whilst continuing to learn his profession as a doctor. Travelling occasionally at great personal risk to see and support his family, he devoted all his waking hours to surgical work in EGH operating theatres and wards. His excellent command of English made him immensely valuable to any visiting surgeons who managed to access Gaza during the war months. He was always cheerful, always willing to respond to requests for his time, however stressful the surrounding clamour from desperate patients and relatives might become.  

When his working day was done, in the middle of the night he would arrange for his fellow students to have informal teaching seminars from whoever he could cajole to deliver them, and would absorb knowledge and ideas about best practice like a sponge. His desire to learn all that could be learnt, and to try to become the best surgeon possible, was palpable.  

I had every intention of supporting this fine young man in achieving his professional aspirations by whatever means I could once a ceasefire arose and he could be brought safely to Europe to continue his training. 

In the last week of August, AbdulRahman was sheltering in a relative’s house in Khan Younis. In the small hours of the morning an Israeli attack was launched on the neighbourhood and the house took a direct hit. AbdulRahman was killed instantly. 

He knew, as does every Gazan in these troubled times, that nowhere was safe, and all lives in that tragic zone are at risk. His is a story of a life tragically cut short, of the randomness and destructiveness of war. His death strikes right at the heart of my hopes for the remnant of the fine young population of such a desperately sad nation state. He, and those like him, could have been at the heart of the re-building of Gaza, able to live in what now feels a far-off peace. I cannot translate this into anger, as AbdulRahman himself had a passionate concern for peace and reconciliation, and never once spoke to me in many conversations of support for Hamas, or of hatred for those who had destroyed his country.  

What can be done however, is to honour his life and commitment with similar tenacity in supporting the pursuit of peace, justice for his people, learning and education for the remnant of the nation, and reconstruction of a Palestine that can proudly and honourably reflect the finest values it possesses. AbdulRahman was a great Palestinian, and his all too short life was one which I want to celebrate as one of the finest I have seen in many students of the next generation of doctors. May he rest in peace, and may a lasting peace come quickly to Gaza, to all of Palestine and the whole of the Middle East.

Article
Comment
Leading
Psychology
Theatre
6 min read

Are you a narcissist?

We all have a little bit of narcissism in us – the question is whether we’re a Moses or an Iago
An Elizabethan man holds a dagger up while grinning.
Kenneth Brannagh's Iago in the 1995 film of Othello.
Sony Pictures.

Is everyone a narcissist these days? It sometimes feels so. Google Trends data shows an eleven-fold increase in searches for “narcissism” between 2010 and 2023, and the term has become a social media buzzword. Online quizzes asking, “Am I a narcissist?” are everywhere, offering dubious self-diagnosis at the click of a button. Genuine Narcissistic Personality Disorder, however, is complex and painful – especially for those in close relationships with someone who cannot acknowledge the harm that they are able to cause or feel any sense of remorse. Narcissus, in Greek mythology, was a handsome young man who was cursed to fall in love with his own reflection, but it was not until the early 20th century that the term “narcissism” was then picked up by the emerging field of psychoanalysis. Initially, Sigmund Freud adopted it in a non-pejorative way to describe the stage in child development when an infant is aware only of their own need for love and attention. Eventually, as that infant grows into a child it begins to experiment with showing others love and attention, and if surrounded by the right relationships, the child learns that love can be reciprocal – a back-and-forth pattern of give and take. Freud wrote:  

“Loving, then, contributes to the lowering of self‑regard. Having one’s love returned, however, restores one’s self‑regard and replenishes one’s narcissism.”  

In its healthiest form, narcissism reflects a positive sense of self – a recognition of one’s own needs and a reasonable desire for them to be met, whilst also knowing that we must give of ourselves, again within reason, to meet the needs of others. In this sense, yes, we are all a little bit of a narcissist. It is only occasionally, most commonly when the early bond between a child and their caregivers is inconsistent or unstable, that this self-focus can become problematically distorted, sometimes leading to a personality disorder. For such a person, a constant hunger for attention and affirmation, often combined with a lack of empathy or a tendency to use empathy as a means to manipulate others, leads to a life of take-take-take; one which can cause significant harm to others and ultimately to themselves.  

Estimates for Narcissistic Personality Disorder are that it affects about one to two per cent of the population, a number which is intriguingly high. The unfortunate news is that true Narcissistic Personality Disorder is notoriously difficult to treat, precisely because key tenets of the condition include a lack of self-awareness and an overinflated sense of self belief. The classic response of the one with Narcissistic Personality Disorder is, of course, “How dare my therapist say that I am a narcissist? They must be the problem!” 

However, much more prevalent are what might be called “sub-clinical narcissists” – people who act selfishly, arrogantly, or manipulatively, influencing others to conform to their desires. We all know one or more of those – sometimes we meet one when we look in the mirror. Whilst this may make us feel pretty rotten, whether we are the giver or the receiver of such treatment, it does not always warrant a clinical intervention. Even so, it can still be extremely difficult to process how and why human narcissistic tendencies are able to cause others so much pain. If, as Freud proposes, a certain degree of narcissism is hardwired into human nature, what can we do about its tendency to evil?  

In Shakespeare’s tragedy Othello, the character of Iago is a master manipulator who displays all the cold-hearted indifference of a true narcissist. Early in Act 1 he expresses his indignation that he has been passed over for promotion. Firmly convinced of his own superiority, he slyly boasts that he will play a false self to Othello, feigning loyalty for his own ends and stating: “I am not what I am.”  

These words are a clever and rather chilling inversion of a famous phrase from the Bible. In the story of the Exodus, God meets with Moses in the form of a burning bush, and when Moses asks for the name of God a voice replies: “I am what I am.” As Moses stands before God, barefoot and awestruck, he hears that enigmatic statement and is forced to confront the question of who he truly is – an ashamed murderer, a fugitive, a short-tempered man of slow speech but hasty acts. Moses acknowledges all these awkward truths about himself and declares himself wholly unfit to be called by God as a leader. Yet God uses Moses anyway, and at the end of his life, Moses dies a celebrated hero – a deliverer who is mourned by all his people.  

Not so Iago. As the tale of Othello draws to its tragic close, Iago is wounded, arrested and escorted from the stage. The audience knows that he has been condemned to execution, but unlike pretty much every other character in that fateful final scene, Iago’s death does not take place onstage. He is simply removed, dismissed from everybody’s notice – a narcissist’s worst nightmare.  

One can see the crucial difference between Moses and Iago – whilst Moses is concerned that his own flawed nature makes him unfit to be become a great leader, Iago is driven to grasp at leadership by a belief in his own grandiosity and acts vengefully when passed over. Right to the end, Iago expresses not one word of self-doubt or regret for his actions. Indeed, he refuses to account for himself at all. “Demand me nothing,” he says at the close; “What you know, you know.” 

Seemingly, the problem of narcissism’s tendency towards evil lies not in actions, but in methods of self-evaluation. While we all make regrettable mistakes, and sometimes it can be hard to judge the difference between unreasonable selfishness and reasonable self-preservation, the true narcissist is afraid to explain themselves, unwilling to bear the judgement of outside scrutiny. The narcissist will look only in the mirror.  

But whereas a mirror only reflects light, a burning bush produces it. In the end, the resources of the Christian tradition do not simply diagnose our narcissism, they offer us a way through it. They offer an outside perspective from which we can truly evaluate our own actions – a light that shines through the mirror.  

If you have ever clicked the link for the online quiz, or been tempted to, then that is an encouraging sign of willingness to be open to outside scrutiny. But of all things, would we really want to trust only human voices, especially the unknown and unknowable voices of the internet, as an authoritative arbiter? If narcissism is so inherent to human nature, it logically takes something higher and brighter than our fellow human beings to really bring it into the light. But in any case, you can save yourself the time of completing that dubious online diagnostic quiz since the whole enterprise can be summed up in just one question:  

Have you ever wondered if you have Narcissistic Personality Disorder? If the answer is yes, you probably do not. So demand yourself nothing, what you know you know.  

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