Upon meeting British-Palestinian plastic and reconstructive surgeon Dr. Ghassan Abu Sitta, you feel like you want to keep asking questions. Having spent 43 days amidst the Israeli offensive on Gaza performing 10 to 12 surgeries per day, Abu Sitta is a witness to the targeting of civilians and systematic destruction of the health sector as one of the means whereby genocidal war and ethnic cleansing is being waged on Gaza. Abu Sitta has not abandoned Gaza and its people during any of Israel’s attacks since 2008. He arrived in the strip on October 9, just hours before the Rafah crossing was closed and the blockade tightened. Besides spending 18 hours every day performing his medical work, he devoted himself to documenting Israel’s systematic goal of making Gaza uninhabitable. He speaks not only about deadly new weapons but also about the occupation’s use of the Palestinian body as a marketing tool, about the new term “wounded child, no surviving family”, and about entire families being struck off the civil records. After al-Ahli Hospital was bombed while he was performing surgery there, he delivered a testimony to the world from in front of its courtyard, which was filled with bodies and severed limbs. His testimony helped challenge the Western media’s adoption of the Israeli narrative that the hospital was hit by a Palestinian rocket in a friendly fire incident. Abu Sitta has also transformed his page on X, which has more than 112,000 followers, and his appearances in the Arab and world media into a platform for Gaza, its people, and his fellow doctors, nurses, and medics – 280 of whom have already been killed.

Abu Sitta places events in Gaza within the broader context of the Palestinian cause. He talks of the astonishing experience of the resistant medical personnel, their connection to the Palestinian struggle since the Nakba [the expulsion in 1948], and the decision of the strip’s hospitals to confront the Israeli genocide by ignoring the threats designed to force them to evacuate; of the solidarity, cohesion, and resistance of Gazan society in the face of the war machine and world of death that the occupation is imposing; and of Israel’s effort to make a show of the killing in order to terrorize Palestinians and drive them out, unaware that the Palestinian collective memory considers the humiliation of becoming refugees a fate worse than death.

The Legal Agenda is publishing its interview with Abu Sitta as an important document attesting to the genocidal war on Gaza.

 

How Does This War Differ from Previous Ones?

The first question we ask Abu Sitta is about the difference between this war and the previous wars that he experienced. His answer is direct: “The difference between them, in terms of size and criminality, is the difference between a flood and a tsunami. They were military wars, whereas this war is a genocide. The goal of this war is to kill. The killing occurs in two stages: the direct killing, and then the killing via the elimination of all necessities of life in Gaza. For example, they dedicated one night to destroying the solar panels in all the hospitals. On another night, they destroyed the desalination plants across the strip. They also targeted universities, presidents of universities, and doctors, especially doctors with specialties otherwise unavailable in Gaza such as Dr. Hammam Alloh, the head of Gaza’s nephrology department”. He reasserts, “They are deliberately and systematically dismantling all necessities of life in Gaza – human resources, homes, roads, or infrastructure – in order to erase any possibility of treatment. It’s genocide”.

According to Abu Sitta, the war has two goals. Firstly, Israel is continuing the genocide of the Palestinian people to eternalize its occupation of Palestine. Secondly, it is using Gaza as a means of developing new weapons, studying their impact, and marketing them. Israel is continually assessing and exhibiting these weapons to market and promote them and, of course, to finish off the genocide.

This is how Palestine differs from South Africa. Whereas South African colonization needed African labor to extract capital from the mines, Zionist colonial capital does not need Palestinian labor but the Palestinian body for the purposes of manufacturing, testing, and marketing weapons. The Palestinian body is the mine from which it extracts added value. Israel earns its money by killing Palestinians and selling the weapons it uses to do so to other regimes that commit the same crimes. Corpses become the laboratory for weapons manufacturing, and stealing corpses becomes part of the process of testing weapons to observe their effect in practice.

 

This Is Why Al-Ahli Hospital Was Targeted

When we ask Abu Sitta about the various narratives of the attack on al-Ahli Hospital, he promptly responds, “As the health sector is one of the fundamental requirements of life, it has been one of Israel’s military targets since the beginning of the war. Today, 75 days into the offensive, only nine of 36 medical facilities throughout the strip remain partially operational. All of them are in southern Gaza”. He adds, “Anyone who asked before the current Israeli offensive, ‘What’s the safest hospital in the Gaza Strip?’, would have been answered – whether by someone in the strip or outside it – ‘al-Ahli Hospital’”. The Anglican Church in Britain “is the party managing it, and the person in charge is also a bishop from Britain”. “Everyone thought that if Israel was going to avoid harming any hospital, it would be this one,” he explains. Hence, he says, “As far as I’m concerned, the Israelis’ decision to strike al-Ahli Hospital was a test of the international community’s receptivity and reaction to their decision to systematically target the health sector”. He says that after the al-Ahli massacre “and Western public opinion’s adoption of the occupation’s Palestinian-rocket narrative without any tangible or logical evidence or attempt to take statements from the wounded or doctors, the Israelis realized that they could continue their systematic attack on the health sector”. Following the bombing of al-Ahli and the killing of 480 Palestinians, “Israel targeted four children’s hospitals” in order to underscore that “even a Palestinian child enjoys no form of protection or humanization”.

Abu Sitta explains that he informed Human Rights Watch of his displeasure with the report its team issued on the al-Ahli bombing, especially as it was not based on interviews with any of the doctors, survivors, or wounded patients who were in the hospital, or any field inspection of the hospital. The report also lacked the testimonies of doctors who examined the wounded to determine the type of ordnance used. Abu Sitta also explains that the organization did not even contact the hospital’s director or the medical director whom the Israeli army had threatened before the attack. He laments that, to this day, the organization has not amended or withdrawn the report.

 

Killing Children to Create an Example

Abu Sitta says that after the children’s hospitals were struck, the cancer hospital was bombed. “This too didn’t occur without reason” as these attacks on healthcare facilities are “a continuous test of how international public opinion will react to the ongoing, systematic and purposeful destruction”. Elaborating on the mechanism of Israel’s criminality, he returns to the moment in which al-Shifa Hospital was surrounded: “The most vulnerable children – namely premature children, who in the social and intellectual system of childhood lie at the top of the pyramid because of the fragility of an organism that needs oxygen, water, and food – were taken and made into examples. The first Israeli tank that entered the hospital turned toward the oxygen pipes and severed them from the maternity ward to kill the children slowly and dramatically”. He believes that this aggressive act was done for show and reflects a key aspect of Israeli violence: the “excessive shedding of blood” as an attempt to “strike terror into Palestinians”. Hence, he deems that openly abandoning the bodies of premature children in al-Nasr Hospital “was not a mistake but a deliberate act that lies at the core of the same show of violence”.

Abu Sitta says, “From the fourth or fifth day of the offensive, we found that half the scheduled surgeries – approximately 10 or 11 surgeries every day in the hospital – were on children”. At the time of writing, 8,200 children and 6,200 women have already been martyred. They constitute over 70% of the 20,000 killed by Israel, not to mention the number of people missing and left under the rubble.

While talking about the children, Abu Sitta pauses for a moment. With difficulty, the “repairer of broken faces in the Middle East” – as the French newspaper Le Monde labeled him – explains that one night in al-Ahli Hospital, he performed amputations on six children. It is no wonder, then, that there are “1,000 to 1,500 children who have had their limbs – sometimes multiple – amputated. This in and of itself requires a colossal effort to reconstruct the bodies”. As Israel’s bombing has mainly targeted homes, “We were receiving wounded from various generations of the same family after every aerial bombing, not to mention the families that were entirely struck from the civil records and the children whose families were severed from them. This war has imposed upon us a new, special category: ‘child without a family’”.

 

When a Family Has to Triage Its Children: Who Gets Surgery?

When the health sector began collapsing, triaging patients became “more difficult and criminal every day”. Abu Sitta says, “In the beginning, triage was based on the conditions of the wounded: we would decide to operate on this person today or bump that person back three or four days”. As resources dwindled, the number of wounded increased, and the hospitals and operating theaters became fewer. “Triage became a kind of diabolical choice between who lives and who dies,” he says sorrowfully. When al-Shifa Hospital was surrounded, al-Ahli Hospital – with just two operating theaters – became the only hospital admitting the wounded. “We were just two surgeons – bone surgeon Dr. Fadel Naim and I – until we were joined by a general surgeon. A decision was made to choose from among 500 wounded people waiting in the hospital: Who do you choose to operate on over the course of the day? It was difficult, and it peaked when the Doghmush Mosque in the Sabra neighborhood was bombed”. That day, the entire Doghmush family, along with their relatives, were brought in: “The family itself began participating in the triage: take this one, don’t take this one, this one has 17 children, this one only has two children”. He describes the gap between the treatment capacity and the number of wounded as “horrendous”, adding that, “I’m certain the situation today is much worse, even though we were unable to operate on anyone with burns of more than 40% or 50% because of the lack of resources necessary for such operations”.

In al-Ahli Hospital, where Abu Sitta continued his work after leaving al-Shifa, “anyone with a brain injury was left to die because of the destruction of al-Shifa and the absence of neurosurgeons, and the tragedy increases when the death is due to denial of treatment”. When he was compelled to leave al-Ahli Hospital because of the absence of anesthetics and closure of the operating theater, 400 wounded were still in the hospital: “It’s like you’re committing some kind of crime, because the wounds will develop bacterial infections, and you’re forced to clean them without anesthetic. This is very painful. When children start showing the first signs of sepsis and bacterial infections, you’re faced with the choice of whether to intervene to clean the wound without painkillers and ketamine, or to leave the child to die at the end of the day”.

When Abu Sitta moved from the north of the strip to the south, he discovered that “the doctors were being forced to perform the same triage because of the severe shortage of equipment and medicine. Ninety percent of the work is bandaging wounds and choosing the patients on which you can operate, and in either case, the choice is painful”. The greatest tragedy lies in the wounds that go untreated: “A wound whose treatment would save the person’s life becomes fatal, and a wound that does not normally lead to a permanent disability becomes one”. Chronic illnesses are also now causing deaths, including deaths of children being treated in the al-Rantisi and al-Nasr hospitals before they were targeted.  Children with diabetes can no longer access insulin, as well as asthma and dialysis patients: “All these treatable diseases have turned fatal because of the interruption in their treatment”. When the supply of antiseptics was cut off from al-Shifa Hospital and then al-Ahli Hospital, Abu Sitta began “buying vinegar and dish soap and cleaning wounds with it”.

 

The Bodies of the Wounded Reveal the Types of Weapons Used

The types of wounds Abu Sitta saw during his 43 days of work in the Gaza Strip reveal many details about the war and excessive use of weapons. He speaks of “200-pound, 1,500-kilogram, and one-ton bombs dropped on residential buildings”, which facilitated the “total eradication of entire families – three generations from the same family were wiped out”. Several days into the offensive, “People came to us with very difficult burns covering more than 50% of their bodies but without shrapnel or fractures. These are the incendiary bombs and bombs with flammable materials that explode and create a fireball that burns people. When al-Shifa Hospital collapsed, there were 100 people who had been wounded by this kind of bomb”. Then the white phosphorus returned: “Its burns are distinct because of [their source], a pasty chemical substance that explodes in the sky and creates a large umbrella of burning phosphorus fireballs. The burning only stops when oxygen is cut off, so the burns continue penetrating the wounded person’s body until they reach the internal organs or bone”. According to Abu Sitta, phosphorus was used “at the beginning of the land forces’ entry into the north of the strip and on the buildings of the Karama neighborhood, as well as in al-Shati camp more widely”. As he had treated white phosphorus burns in the Gaza Strip in 2009, he knew well the kinds of wounds and burns it causes, and he saw them on the bodies of the wounded.

The wounds caused by the attack on al-Ahli Hospital tell of a new generation of Hellfire, a drone-launched missile that disintegrates into metal shards and dismembers bodies. This dismemberment, Abu Sitta says, occurs in unusual locations. “Explosions, for example, cause dismemberment in the weakest area – the joints – and in children’s bodies. But this weapon dismembers at the mid-thigh, for example, which is the strongest area of the body”. He witnessed the use of this weapon when he treated the wounded from al-Ahli Hospital and the Doghmush Mosque. Thereafter, Israel began using it frequently because it achieves the maximum number of casualties. “When I left the operating theater following the explosion at al-Ahli and was on my way to the emergency room,” says Abu Sitta, “I saw the hospital courtyard from which I had entered that morning, where people had sought refuge. It was ablaze, illuminated by the fires caused by the bombing. The courtyard was filled with bodies and severed limbs. In the emergency room, I saw the first of the wounded: a man whose leg had been severed at the thigh. The dismemberment looked like it had been done by a guillotine, different from any other wound. The blood vessels were still hemorrhaging, so I had to tie his thigh with a belt to stop the bleeding. The second wounded person had been hit by a fragment in his neck, and blood was flowing out. All the wounded were hit with metal fragments”. An ordinary rocket creates a hole in the ground and explodes. Most of the fragments consist of stones and earth, and the wounds it causes are different. “The wounds from  Hellfire are caused by the metal from the fragmenting missile,” explains Abu Sitta, “and the number of wounded and an inspection of the blast site show that”.

The people wounded in the vicinity of the Jordanian Field Hospital – which Israel cannot justify targeting without causing a diplomatic crisis as it is managed by the Jordanian Army – reported that a drone fitted with a sniper rifle has joined the lineup of new weapons. Drone fire wounded 20 people in the vicinity of the Jordanian and al-Ahli Baptist hospitals in one day. Drones were also used to “hunt people when they have to go out to buy water and food in the markets and the old city in Gaza”. The fragmented bodies also revealed the new technology of the flechette missile “that was used in South Lebanon. At that time, it was made from small arrows. Today, it fragments into long, sharp metal shards that hit the targeted people”.

 

Resistance to Israel’s “World of Death”: Medical Personnel and the People

In the face of what he calls the “world of death” that Israel is attempting, through its crimes, to impose on Gaza and its people, Abu Sitta details Gazan “everyday resistance”: “The idea of a person resisting death and killing persists despite the criminality, as does human cooperation and togetherness. Families that don’t know each other take refuge in the same home, families shelter strangers, families embrace wounded people and their families, and families embrace children who have no families because they were the sole survivors”. He says that Gaza’s medical personnel amazed the world while Israel was destroying the entire medical sector: “It’s astonishing that when the Israelis released the doctors, nurses, and medics who had been blockaded in al-Shifa Hospital for 10 days without food and water, they immediately looked for another hospital to join. Colleagues of mine in al-Shifa have now joined al-Awda Hospital in the north or al-Ahli Hospital”. Even when it comes to the doctors who left with their families for southern Gaza, “the first thing they did once they settled was look for a hospital and start working there. The same goes for the nurses and medics. Despite the systematic destruction of the health sector, resistance endures inside it, just like the other sectors of Palestinian society”.

Meanwhile, more than 280 doctors, medics, and nurses have so far been systematically killed: “Israel was targeting them the moment they returned to their homes in order to create a disaster that keeps the genocide and ethnic cleansing going after the war. [Israel] kills more than 20,000, wounds more than 50,000, and leaves the wounded to die in front of their families”. He adds, “This is a way to drain and slowly kill the wounded and their families after the fire ceases in order to push them to leave Gaza, even if they had chosen to stay”.

Doctors were killed with their families. Their families or family members were killed, and they continued working. “When the wounded and dead arrived,” says Abu Sitta, “the doctors would run around madly to check whether their children or families were among them”.

Abu Sitta mentions that al-Awda Hospital in Jabalia was the first to receive an eviction order (he was there at the time). A decision was made not to yield to the threat by evacuating the hospital. This decision then snowballed. All medical personnel felt that they – like al-Awda Hospital – would be threatened sooner or later, so the decision not to evacuate was adopted across Gaza’s entire medical sector.

This determination to confront and resist the world of death is displayed not just by the medical personnel but also by the people. After the last operating theater in al-Ahli Hospital was closed, there was a 13-year-old child whose mother and siblings had been killed but he had survived with his father. However, his right leg had been amputated, and he needed reconstructive surgery on his crushed hand. “I told the child’s father that I could be in a hospital in Nuseirat,” says Abu Sitta. Traveling from the north of Gaza to the south takes five hours, as Israeli tanks have torn up the asphalt. “It was difficult for an old person to walk and impossible to push a wheelchair or suitcase. Over six hours, this father pushed his son – the only person he had left – and joined me in Rafah, where I performed the surgery”. This is what Abu Sitta calls “resistance to the world of death by the families and wounded as well”.

Abu Sitta returns to the subject of the doctors, nurses, and medics, and speaks about the extraordinary effort they have made in the face of the genocidal war and ethnic cleansing aimed at depopulating the Gaza Strip. He deems that this resistance stems from the historical connection between the Palestinian struggle and medical work. The Palestinian view of resistance by medical personnel is an extension of a long path that began in the wake of the 1948 Nakba: “This unique Palestinian view of health as a fundamental part of the struggle against the Israeli occupation and Israel’s elimination of the Palestinian body has, in this war, manifested itself in the form of an astonishing effort in the hospitals of northern Gaza. The al-Awda Hospital, for example, was bombed several times and continues to operate. Al-Ahli Hospital was struck multiple times and continues to operate. The hospitals of the south all continue despite a lack of resources. No hospital closed for the sake of closing”. He concludes emphatically, “My career is an extension of this Palestinian medical legacy”.

The same legacy led him to realize on the night of October 7 that a very difficult war on Gaza was coming. Consequently, he arrived in the strip before the blockade was tightened and the crossings closed. Today, armed with the same legacy, Abu Sitta is waiting for the health sector to recover its ability to function and for the first humanitarian corridor to open so that he can return to Gaza, even if the Israel offensive and crimes are still underway.

 

Pursing the Crimes Documented in Gaza

Abu Sitta reveals that as soon as he arrived in the UK, his lawyer was contacted by Scotland Yard’s War Crimes Unit, the job of which is to interview any British citizen or resident who witnessed or was a victim of war crimes. For several hours, he delivered his testimony about the entire Gaza experience, particularly the attack on al-Ahli Hospital. By contrast, he has received no call from the International Criminal Court’s prosecution office, although he heard from the British unit that his testimony will be passed on to it.

Abu Sitta explains that his communication with international organizations has been limited to Human Rights Watch. As stated above, he contacted the organization to convey his displeasure with the report its team issued. In this regard, Abu Sitta expresses his astonishment at what happened after the bombing of al-Ahli Hospital. Within an hour of the bombing, the Israeli narrative that the explosion was caused by a Palestinian rocket was repeated without any doubt or scrutiny from the global media or international organizations. It was up to the victim to prove otherwise. The questions that the global media usually asked him when discussing Israeli attacks on hospitals were questions like: “Did you see anyone under the hospital? Did you see tunnels and trenches under the hospital?”, which reflect the adoption of the Israeli narrative.

 

Gaza’s Future

We ask Abu Sitta whether he expects Gaza to recover from this genocidal war. He responds: “Gaza will heal if it is allowed to heal. My fear stems from my realization that the goal of the war is to expel Palestinians from the Gaza Strip and that Israel will try, as always, to achieve after the war what it couldn’t achieve during war. The war aims to make the strip uninhabitable by destroying all the hospitals, residential buildings, universities, schools, and infrastructure, and targeting human resources in the medical, basic necessities, education, and cultural sectors, among others. The goal of all this destruction transcends the war to encompass, specifically, the post-war period, along with undermining the resilience [sumud] of Gaza’s people”.

He continues: “When the people are left without homes or schools and the wounded are left to die in front of their families over years, the aim of all this is to end the Gaza Strip. The blockade is a continuation of the war and one of its tools, and this is also an international decision. In this war, it has become evident that it is also an American decision, supported internationally and implemented by everyone, and it could lead to a continuation of the blockade if it doesn’t change. For example, schools have turned into places of residence for the displaced, and approximately 70% of schools are out of service”. “If Gazans are allowed to build the strip, they will rebuild it. They need that decision, not aid,” he laments.

Abu Sitta points out that during this war, a factor that the Israelis did not anticipate has emerged. When Israel decided to commit a slaughter and spill rivers of Palestinian blood, it thought that threatening Palestinians with death would cause them to seek survival, i.e. the usual reaction. It did not foresee that to the Palestinian collective memory imprinted with the Nakba of 1948, there is something worse than death: the humiliation that would be felt as refugees. Hence, he anticipates that the people will resist until the very last moment in order not to become refugees once more, as evidenced by the fact that so far, more than 700,000 Palestinians are still living in the north of the strip and more than 160,000 are still living in the Jabalia camp. Gazans are also still living in Beit Lahia, which is closer than Jabalia to the direct fire.

 

Ghassan Abu Sitta After October 7

When we ask Abu Sitta about how he has changed since October 7, he responds in his Palestinian dialect, “Anyone who says that nothing has changed is kidding himself”. He continues, “My view of myself has changed. I discovered things about myself that I didn’t know. For example, I didn’t think I could work 18 hours a day for 43 consecutive days. I have the sense that a person is much stronger than he expects, physically, mentally, and psychologically. Other than that, I need some time to understand the actual impact of what I experienced”.

Abu Sitta explains that he left Gaza after he spent two days in the hospital unable to enter the operating theater because of the lack of supplies and fuel. His decision to leave was based on the collapse and destruction of the health sector: the presence or absence of a surgeon no longer mattered because of the destruction of the capacity of the operating theaters and lack of medical supplies. “I left because once we had been incapacitated as doctors, my work was over,” he says. He adds, “Yes, there are 50,000 wounded, 70-80% of whom need surgeries. Therefore, the moment the health sector’s capacity is rebuilt, it can stand on its two legs, and a humanitarian corridor is secured, I’m going back to Gaza – even if the offensive hasn’t stopped”.

 

This article is an edited translation from Arabic. Part 1 | Part 2