Sam Seder (interviwer): Sam Seder, Emma Vigland on the Majority Report. It is a pleasure to welcome back to the program Dr. Tarek Loubani, Canadian emergency room physician. He runs the Glia project, which seeks to provide medical supplies to improvised locations, and has been stationed in Gaza for at least a year now. I know that you spoke with Emma. You’re now at Nasser Hospital near Khan Yunis. Why don’t we start with that — what has changed over the past year?

Dr. Tarek Loubani: Yeah, a lot has changed here over the past year. I’ve been in Gaza this time for the past two and a half months, so not quite a year. But even getting in was incredibly challenging because the Israelis of course will prevent anybody from entering, and have been constantly banning any international medical groups — or any medical groups at all — from entry. Since we spoke, Glia has been banned by the Israelis for reasons unknown, and only through some herculean diplomatic efforts were we and the six other organizations that were banned with us allowed back in.

So what’s changed in the past year?
All of the Palestinians who I see are more impoverished. There are of course many more people killed, and everybody is starving. Over the past year, almost everybody that I’ve met has been forced out of their homes at least once — some of them two, three, four times. And the amount of food that has been coming in has progressively dwindled to the point that now when I see patients, almost everybody is starving. Really, truly — every patient who I see, I can clearly make out their spine, I can make out their scapula, their shoulder blades. I can see how much weight they’ve lost, the skin that’s hanging off of them — that shows me what they used to look like before the war. It has been grinding. It has been painful and it has been progressive. And of course, as you know, it’s all been driven by this depraved, almost maniacal Israeli policy of making sure that Palestinians can’t live.
Emma Vigland: When you talk about the starvation, can you explain from your perspective as a physician what starvation does to the human body — especially once you get to a certain point where it’s difficult to reverse even if nutrition was going to be provided immediately?

Dr. Tarek Loubani: Yeah. I’ve had a good look at starvation for quite a while. I myself have been on several hunger strikes, especially when I’ve been previously jailed. I’ve followed people on hunger strikes. I’ve seen people in famines. And of course in Palestine, Palestine has been the subject of restriction of food for many years. Dov Weisglass, in I think it was 2007, was an advisor to then Prime Minister Ehud Olmert and started what he called the “Gaza diet” — a caloric restriction program that made sure that Palestinians didn’t have enough literal calories. They literally counted how many calories were allowed into Gaza and made sure that there weren’t enough for every Palestinian.

[Translators’ note: Weisglass did make this remark, but in February 2006, when he was a senior adviser to PM Olmert. He did not himself run the calorie-counting policy; the full blockade of Gaza was imposed in June 2007, following the Hamas takeover].

But all of these programs still allowed for the fact that Palestinians could do their own thing. And so actually, one of the biggest reasons why there’s a famine right now isn’t the cutting off of aid, but rather the complete razing of almost all agricultural lands. Something to the effect of 98% of all agricultural lands have either been heavily damaged or completely razed. So when Palestinians were able to obtain a measure of self-sustainability, that self-sustainability was taken — when their lands were literally bulldozed. And when anybody who went to try to replant the land was killed and shot, as though they were some kind of freedom fighter, when they were just trying to raise some animals or plant some simple crops. Even now, in the midst of the starvation, almost the only food that is here is food that has been grown by Palestinians.

In terms of what it does to the body — I can describe some of the scenes. I’m not a pediatrician, but because this is not the thing I see the most, I decided to go to one of the malnutrition wards. And of course the malnutrition ward is based in the pediatric hospital, because the people who are the most impacted by malnutrition are the kids. Malnutrition and these famines impact the weakest people in society.

So when I first got to Gaza two and a half months ago, what I was seeing was that the old people and those with pre-existing medical problems, and the young kids — they were the ones who were dying of malnutrition and who looked like they were clearly suffering. They looked just like you’d imagine out of the textbooks — they really did look like skin and bones, barely surviving.

And I remember the first little girl I saw — less than a year old, I believe she was about eight months old. Her father had brought her in because he thought we could do something to help her, and she was dead. He put her on the table in front of us and I looked at her and realized: this little girl has died because they couldn’t feed her. I asked him some questions — half because it was my job medically, half just out of curiosity about how exactly this happened. Since the beginning of the war, she had had very little access to nutrition. There was no formula available. The formula that was available was incredibly expensive and so out of reach for the family. And when they came to the hospital, the little formula that they were given as part of the hospital treatment was simply not enough. They took lentils — which at the time was the only thing available — mixed it with water and tried to give that to her as a kind of formula. That doesn’t work. It didn’t work. She died. And I realized, looking at her — she was eight months old, but she looked like she was three or four months old, and she had a weight about as much as a newborn baby.

In that specific case, before we could even say too much to the family, a mass casualty started and they were off to the morgue, while we dealt with all these other Palestinians.

But every single Palestinian who I see at this point — their body looks emaciated. You can see clearly the bones through the skin. You can see clearly the impacts. At this point, the people who are severely malnourished will die. They will all die. That is thousands if not tens of thousands of people. And that’s not because it’s impossible to fix their problem — that’s because Israel will not allow us the materials and the supplies that we need to fix their problem.

And so even when Israel did start allowing supplies in, like they have over the past week — yesterday I ate a little piece of meat for the first time in three months. A little piece of meat. Now that those supplies have started coming in, they’re still not enough. It’s still too little. We are receiving by caloric count 60% of the population’s needs. So even though we’re now eating, most of us are eating one meal a day. And the people who are starving need massive numbers of calories — but not only that, they need nutritious calories. I can’t just give them rice, which is what’s available. I can’t just give them lentils, which is what’s available, or yesterday what arrived — some kidney beans. I need to give them highly nutritious foods that include vegetables, greens, vitamins. And that’s why the people who are so deeply malnourished are going to die.

Sam Seder: My understanding is that the severity is creeping up the spectrum — across the spectrum of healthy people. I mean, the more vulnerable you are healthwise in the best of times, the more susceptible you are to succumbing to this. Do you have any sense that the Israelis’ claim that food supplies are being intercepted — is there any talk of that? Or is it simply just not coming in?

Dr. Tarek Loubani: I think it’s very clear. First, anytime we discuss any Israeli statement, it has to be prefaced with: the Israelis are war criminals and serial liars. They lie basically about everything — including, you know, yesterday their pronouncements about the journalists who were killed. The Israelis are war criminals and liars.

In this specific case, let’s expand upon how they’re lying. They’re lying in two ways. The first way is that there isn’t enough food coming in. The whole premise of food being looted and diverted is the fact that there isn’t enough food for people, and so it creates a dynamic where people can sometimes compete for it. If there was an orderly way in which food could be given to people, that simply wouldn’t exist. So yes, there is some food being looted — but the primary reason for that is because the food is not sufficient.

However, here’s another question: where is the food being looted? Where are these things happening? They’re almost universally happening in what are called red zones — areas that the Israelis themselves protect and enforce. And the people doing the looting are Israeli-sponsored. They are gangs like the gang of Abu Shabab. They are groups of people who are literally under the protection of the Israelis. And anytime Palestinians — whether Palestinian families, Palestinian police, or the Palestinian citizenry — anytime they fight these gangs, what they find — and I’ve literally seen this — when one of these gangs attacked the hospital about a month and a half ago, the Israeli quadcopters and drones showed up and started protecting their goons and killing anybody who was trying to bring order back to the situation.

Sam Seder: So you’ve experienced being under attack at Nasser Hospital, and Israeli military — basically these drones — coming in and fighting alongside one of these gangs. And just — I don’t know that people have a full awareness: Hamas exists in the context of Gaza, but there are competing gangs, particularly now. And we see this whenever you destroy the infrastructure of a country — competing gangs start to rise, and some are being supported actively by Israel, ostensibly as a way of fighting Hamas, but also as surrogates for Israeli forces.

Dr. Tarek Loubani: Yeah. Let me paint you a picture of the attack on Nasser that happened in June. The first thing to say is that that attack — the last attack, the one I’m going to describe — was the sixth attack on Nasser within a three-month span. We’re not talking about something that rarely happens. The Israelis attack Nasser and other hospitals regularly. Yesterday, they destroyed a good portion of the emergency department while they were assassinating journalists. The Israelis attack Palestinian hospitals regularly.

The way this happened: I was in the accommodations for international doctors and healthcare workers, relatively high up in the hospital. And all of a sudden it was like all hell broke loose — shooting everywhere, by all manner of heavy and light weaponry. We all bunkered down, went to the ground. Being an emergency doctor, and this having been the third attack on the hospital, I knew I needed to get to the emergency department. So I ran down to the emergency, where these gangs were trying to break into the hospital, shooting at anybody they could. They killed I think four or five people in the hospital within the two days before — that was a third attack in three days.

We took our patients to the ground. I remember this one little girl who was there with a chest tube and her family around her — there had been a bombing, she caught some shrapnel from an Israeli strike that had gone into her chest. We put in a chest tube to drain the blood that had accumulated around her lung, and we put her to the ground. She was six or seven, of course, terrified. Her family around her were terrified too. And we just sat there while these gangs attacked. One of the things that was unique was that we heard the quadcopters protecting them, pinging off anybody who was firing back or trying to protect the hospital. And then finally there was a drone strike just before the Palestinian police were able to repel the gang.

Of course, the responsibility was taken by Yasser Abu Shabab in a Facebook post — we’re not speculating about who did this. Yasser Abu Shabab said: yes, we were supported by the Israelis because we are doing the right thing. That’s what he said in his Facebook post. He took down the post — I think when his handlers realized how damning it was — but they had taken full responsibility.

I want to pull back to what this is really about. The Israelis are interested in deep chaos in Palestine. Palestine is not a chaotic society. Palestine is a very highly ordered society and people know how to self-organize. I was amazed the first time I went to one of these refugee camps with tents. The tents were almost put by a laser line — all lined up, no tents out of line, little streets. People were organizing, providing supplies, making sure that the very little that was available was available to everyone. There is no disorder by nature in Palestinians or Palestinian society — or I would argue among anybody anywhere. In disasters, we usually see people self-organize and be very good to each other. So Israel keeps trying to stoke these flames of civil unrest among the Palestinians and the different factions.

Sam Seder: What entities end up protecting the hospital from these assaults?

Dr. Tarek Loubani: It’s the Palestinian police. They still exist — they have to be relatively undercover, but they’re around. Like any other police, some of them have light weapons, guns, some light assault rifles. And they are the ones who everybody, regardless of faction, is hoping will be able to protect us when these guys show up. When the gang showed up that first day and started killing people, executing people in the emergency — all of us, regardless of faction, regardless of creed or belief, were all hoping that the police would be there to protect us, that the hospital security would be there to protect us.

There is also one other main faction your audience might have heard of, called the Arrow Unit. The Arrow Unit is a kind of internal protection unit that tries to put down these types of disorders, has targeted Abu Shabab, and has killed members of Abu Shabab. Yesterday, for example, by Nasser Hospital, some members of the Arrow Unit had brought a stolen truck loaded with flour that had been stolen by one of the gangs, and just left it at the gates of the hospital so that people could take whatever they wanted. Nobody sees them. I don’t know what they look like. Nobody knows what they look like. They show up, they disappear. It was obvious that it was The Arrow Unit.
Other than The Arrow Unit that is technically a subdivision of the Palestinian resistance — which at this point is a combined operation between all of the armed factions. It’s just the Palestinian police: a civilian force answerable to whatever democratic forces still exist within the society.

Sam Seder: What do you know about how many hospitals are actually functioning at this point through the Strip?

Dr. Tarek Loubani: We have to take a very liberal view of what the word “”functioning”” means. Think about what it looks like to have a hospital that works. You’ve probably been to a hospital at some point for yourself or a loved one, and there are certain expectations. You expect your doctor is being paid — well, salaries are very rare here, very difficult to come by. You expect your doctor was probably able to sleep the night before — well, almost all, if not all, of the medical staff I worked with yesterday were sleeping in tents. I worked a 24-hour shift yesterday. You expect they’re fed — well, doctors are literally passing out on the floor sometimes because they’re so underfed. We’re eating what the population is eating. For literally over a month, the most I used to get was a literal handful of rice or lentils. And I want to know — I am an international. I literally have access to the most of everything. And still, that’s the food we were receiving — the same as everybody else, provided out of whatever aid came through.

So when we say a hospital is “”functioning,”” we’re talking about an absolutely Sisyphean effort that Palestinians put in — showing up despite losing family members, despite sometimes being wounded themselves, despite having nothing or definitely not enough to eat, and despite none of us having adequate equipment. I have so many stories of patients I saw and wished I could do more for. Patients who were so eminently treatable and I couldn’t treat them because of a lack of supplies.

Every day it’s like a surprise — what exactly we’re going to be lacking on that particular day. Yesterday was glove day: there were just no gloves. So I wore one glove, tried to deal with the patient as much as I could, and just washed the other one when it got full of blood. Another day it was gauze day — simply no gauze. Medications are almost 80% at severe shortage and 50% at complete stockout — zero supply. Pain medication, intravenous antibiotics — almost all of them are out in Gaza.

Yes, the hospitals are functioning — but they’re functioning despite these severe shortages, and really only by the most liberal definition. There’s Nasser, the hospital I’m at — it is the best functioning. Then there’s Dar Al-Shifa Hospital. And then Al-Shifa Hospital. That’s it.