Dr. Morgan McMonagle (video diary – live, during hospital strike):
So currently in our hospital ICU, about 20 minutes ago the hospital was hit above the emergency department, second floor. We heard an enormous explosion and the entire hospital rattled. So, we were told it was hit by a missile. We don’t know — that’s what we’ve been told — but the second floor is on fire and we’re taking shelter in the intensive care unit with the double wall rule. So, we have two critical patients that we were just about to bring back to the OR for bleeding internally. One was a transfer in, one was a case from earlier on. So, with a lot of vulnerable patients in the ICU as well, and we’re waiting for our security to give us the go ahead. We’re not sure what’s going to happen. Maybe we’ll be evacuating.

Dr. Morgan McMonagle (video diary – retrospective account):
So, it’s the early hours of Monday 24th of March. On the evening of 23rd Sunday, we were in the ICU department at Nasser Hospital on the fourth floor. We had two very critically ill patients who were bleeding from wounds from earlier in the day — from shrapnel, from blast — and we were debating which one to take back to the operating room first when we heard a very loud explosion and the entire floor vibrated and rocked slightly. And only then we heard the panic that there was a hit on the actual hospital, which turned out to be a hit on the second floor, male department, surgical department, where we have a lot of our patients staying post-surgery. And some people were killed.

Dr. Morgan McMonagle (video diary – with patient): Good morning. You alright?
What’s he saying?

Medical aid: He’s asking, “I want to go home.”
Dr. Morgan McMonagle: Do you know if his parents are alive?

Medical aide : Now his family — his mother is injured. She is in the female surgical ward. Also, he lost his siblings. He’s the only living kid for his parents. His mother is injured and his father is fine.

Dr. Morgan McMonagle (video diary – walking through ICU):
So, it’s been a very eventful 24 hours walking through ICU now. We spent pretty much most of the night in the operating room. We had blast injuries — multiple blast injuries — but the worst case was probably what sounds like an Apache helicopter. Two young children were brought in dead, probably four and five years of age. And then we had a girl, 11 years of age, with severe lower limb injuries and upper limb injuries from bullets from an Apache helicopter. Extremely unwell. We repaired her brachial artery. She has a very high chance of losing both lower limbs because of the soft tissue loss and fractures, and also soft tissue loss and fractures of her upper limb. So, 11 years of age. And her dad came in with severe injuries as well. He died during the night. Her mom I believe is still alive. So that is the reality of what we’re dealing with.

Narrator / Presenter:
Victoria spoke to Morgan McMonagle yesterday. He volunteered in Gaza with Medical Aid for Palestine. And again, I must warn you that this interview contains distressing details from the start. Vic began by asking Morgan McMonagle for an update on the health of the young boy in his video diary.

Dr. Morgan McMonagle (interview):
Well, when I left — I’m back six days now — he was doing well. He was the first patient that we operated on when the ceasefire was breached on the morning, the early hours of Tuesday the 18th of March. He was one of the few patients in the first wave that arrived who had severe injuries. He was very quiet. Sick injured children who were quiet are always more concerning than children who are crying or screaming, because a quiet child is an unwell child. We did spend the first 20 minutes pronouncing people dead, of which most of them were children. Many of the adult dead were brought straight to the mortuary, especially the men, but a lot of the women and children were brought straight into us. Once we got through that first wave, we were treating him on the same trolley as two other children. So, one bed, three kids who were all critically injured. And eventually someone had to make a decision that we need to start operating. So, I picked him up and ran up four flights of stairs to the operating room. I didn’t trust the elevators after, you know, because those bombings were going on. I didn’t want to get stuck in an elevator with a dying child. He had his abdomen open. He had some bleeding in there that was taken care of, and he had a popliteal injury, which is the main vessel behind your leg, which was repaired in a 5-year-old child with no microsurgical equipment. You saw in the video the foot was doing well and I was very pleased. But he also has a lot of other damage including bone and muscle and nerve. So, there’s still a high risk that he will end up losing that leg. But when I was leaving, he was starting to behave at least like a normal child. He was complaining and giving out. I met his dad who gave full permission to use the video. His mom was injured — I think she may have lost an eye, I’m not entirely certain. And he had two, if not three, siblings also dead.

Interviewer:
And we heard you ask, “Are his parents alive?” And I wonder how many times you might have asked that question when you’re treating a child in the period of time you were working in that hospital.

Dr. Morgan McMonagle:
Yeah. And most of the time there was at least one parent dead or severely injured. There was a child in the bed next to him who was the second child I operated on, who was also still alive and doing well when I left. She was about five or six. She had a kidney injury, liver injury, I took her spleen out, and some bowel injury. That’s what shrapnel does — it is very high velocity sharp metal flying in all directions and its thousands of pieces. But we discovered after we woke her up from the ventilator two days later, she had a piece of shrapnel in the left side of her brain. So, she was completely paralyzed down the right side of her body. We had another child who was one year old who had some shrapnel injury to the belly, and when that child woke up, he was calling for his mom, but his mom was dead. The youngest child I operated on was about four or five months. And I’d say the average age was between maybe 8 and 14.

Interviewer: From the moment the ceasefire broke down, March the 18th, you worked for something like 20 hours nonstop. In the first 20 minutes or so, you’ve already said you pronounced many children dead. Do you know how many? Can you recall?

Dr. Morgan McMonagle:
Oh, there were five or six NGO members all doing the same job, and there were the Palestinian doctors and nurses there as well. I would say in the first 20 minutes I personally pronounced probably between eight and twelve dead — all children, children and women. There was a handful of men. But I did go to the mortuary the next day briefly, and I’d been to the mortuary before. There are two rooms in the mortuary that can hold 25 bodies each — full, including bodies on the floor — so that’s at least 60 to 70 bodies. And then on the floor of the mortuary were lots of other body parts. So, it’s really hard to count how many were horrifically killed. Many unrecognizable, so they’ll never be claimed. Or even if they are recognizable, often family members are dead as well and they’ll just get put in a mass grave, unmarked. And that’s the reality. Children included. But I did notice when things settled down, around about lunchtime shortly into the afternoon when I left the operating room and got a drink of water, I walked through the intensive care unit — it’s a 20-bed intensive care unit — every single bed was full. I went back about 7 or 8 in the evening because that’s the time they break their fast. The intensive care unit was only half full because they had all died. And that’s the reality when you’re dealing with a mass casualty situation.

Interviewer:
Now you are talking about this in really matter-of-fact terms. What you are describing is unbelievably distressing. Obviously, it’s your job — I totally get that, that’s why you went out there to help. But how do you process what you saw?

Dr. Morgan McMonagle:
So, when something like that happens, you kind of click into that professional mode where you have to get the job done and you want to do the very best for the greatest number. And like I said, I had experience at St. Mary’s Hospital during Grenfell, Westminster Bridge, London Bridge. I worked in the Queen Elizabeth Hospital Birmingham in the military wing at the height of the last Iraq war when a lot of young servicemen were coming back with horrific injuries. But this by far was the worst. I worked at a big urban center in North America where we saw eight to ten gunshots a night, but nothing compared to this — because of not just the sheer scale of it, but really the numbers of children who are severely injured. And I mean really severely injured. That is 100% man-made. And I don’t mean mankind — I mean man-made. Some people get very upset. Most people in humanitarian work in a conflict zone can process their own anxiety and distress, and we’ll often discuss it with the team later. But I have to say when things finally calmed down, I felt a lot of anger. I felt a lot of anger because it’s fully preventable. I felt a certain amount of anger that I allowed myself to be put in a position where I have to take care of extremely sick children who should never have been that sick. And then later that gave way to guilt. Some of the Palestinian doctors are really tremendous, doing a tremendous job. And during the height of the conflict, they were dealing with this every single night. Every single night. And you could see it. You could see how they clicked into action. So, I felt a lot of guilt when I was leaving. And I’m not afraid to say it — I’m a white Caucasian male from the western world. The luxury and the elitism that I can leave — there are forces out there at government level and NGO level that will get me out. But I’m leaving some very sick patients behind in a zone where it’s going to happen again, and colleagues that are going to deal with it again and again.

Interviewer:
On the night when the hospital you were working in was hit — it is a fact, and I’m just letting our audience know this, that among the dead that night, according to Hamas, was a senior Hamas leader. They say he was being treated there. The IDF say that is false — he was there for terrorism acts. When the hospital was hit, presumably you spring into action, you’re not thinking about your own survival.

Dr. Morgan McMonagle:
Well, we were on the fourth floor. Most of our activities are on the fourth floor of the hospital, which is the top level. So, we had our accommodation, the intensive care unit, and the operating rooms all on the one floor. The second floor was hit — the male ward. It was a ward that I was on every single day doing rounds, seeing patients, doing follow-ups. In fact, I had planned to go down to that ward later that night to see a patient — I’d repaired a brachial artery and a gunshot wound earlier that same day, and I usually like to see those before I go to bed, it helps me sleep.

Interviewer: So, you could have been killed.

Dr. Morgan McMonagle:
Potentially, and I’m actually amazed no staff were killed — I really am amazed. We see the destruction inside the ward, and as I’m not a ballistics expert, but as far as blasts go, it’s small compared to some of the buildings that have collapsed. But it killed the target and one other — a 16-year-old boy who we had operated on two days before. And the only reason why I probably wasn’t there was because we were in the intensive care unit with two sick patients who needed to go back for bleeding to the operating room, and we were trying to decide which one to go first when we heard the blast. At first, I thought it was a blast outside, and then within about two minutes our security people said no, the hospital has been hit. So, you do wonder — are we now a target? It took about 20 minutes for information to come through that it was a targeted hit and that the hospital wasn’t the intention per se. But we all know that it is against the rules of war and all humanitarian codes of practice and conduct and the Rome Statute of 1998 that you do not target healthcare or healthcare facilities. But it is happening, and it’s not just happening in the Gaza war — it’s happening in other wars around the world.

Interviewer: Of the many patients you treated, who stays in your mind?

Dr. Morgan McMonagle:
That little boy, because he is a success story and I hope he keeps his legs. I really do. And I’m keeping in contact with some of the doctors looking after the MSF limb reconstruction unit there at the moment. The 5-year-old who I had to open the chest and abdomen without a scalpel handle stands out, because despite having managed horrific injuries across the board, mostly in adults, I’ve never had to do that in a child before. And although the child was alive at the end of surgery, he died about eight hours later. So that child will always stand out.

Interviewer: Thank you for being with us. Thank you for talking to us and to our audience. Dr. McMonagle, thank you.
Dr. Morgan McMonagle: Thank you.