The Majority Report Podcast hosted by Sam Seder:
Sam Seder: Joining us now, Dr. Ambereen Sleemi. She is a Brooklyn-based doctor and she’s the executive and surgical director of International Medical Response. She has just returned, I think it was on Monday, if I’m correct. And I appreciate you joining us. I imagine you are still recovering in many ways from being stationed in Nasser Hospital in Gaza. Doctor, welcome to the program.

Dr. Ambereen Sleemi: Thanks for having me, Sam.

Sam Seder: Well, just give us a sense of, just on the purely data points. How long were you in Gaza? Were you stationed in in Nasser Hospital the entire time? How many times have you visited Gaza over the past, etc.?

Dr. Ambereen Sleemi: Sure. I was supposed to be there for 3 weeks and originally, we were going to go up to the north to one of the hospitals there. But the security situation had deteriorated to such a point that they put us in Nasser Hospital, which is in kind of in the middle of Gaza. And I was supposed to be there for 3 weeks, but on the day that we were supposed to exit, there was a real increase in bombing and security concerns. So our leaving was cancelled, and we didn’t leave until half a week later. So it ended up being almost four weeks. I think I answered all your questions.

Sam Seder: Was this your first trip to Gaza?

Dr. Ambereen Sleemi: Oh, yes, it was. But I have been trying to get to Gaza for over a year. So, I was really thankful when the group that I finally connected with said, you know, can you be ready in like 3 weeks? And I was like, sure. And then they said, are you able to go for three weeks? And I said, sure. And then the next thing I knew, I had a plane ticket and was ready to go.

Sam Seder: Give us a sense of what you saw over the course of those near four weeks, and if there was a change over the course of these weeks in terms of the casualties you saw as the Israeli bombing went on, and where there … I mean there were reports today of dozens who were killed, and at least a dozen of those were seeking aid, and they were brought to Nasser Hospital. Give us a sense of what you saw.

Dr. Ambereen Sleemi: I will, thank you. Well, like I said, it started off with our original logistics being a little changed because of the security situation. And then in the first few days at Nasser, it turned out that in the past they used to have people go back and forth between a guest house and the hospital every day. So we’d be transported and then brought back, unless we wanted to stay for overnight duty. But the security had deteriorated because of the increase in the Israeli bombing, the increase in the quadcopter shooting, and also because we were very close to one of the primary GHF food sites, So there was a lot of Israeli military presence close to Nasser. So all of those original plans and how they had done things logistically, had gone out the window, and we ended up just staying in the hospital, which is what all the teams did. We were not going back and forth, and we were not able to leave the actual hospital compound because of security concerns. And in the first few days that we were there, we had gotten notices from each of our groups. The logistics people said that the security situation had really deteriorated, that there were tanks right outside — on the roads right outside. There was bombing constantly and we could tell it was getting closer because the entire hospital shook at all times. You know, at nighttime, if you’re sleeping, it wakes you up. During the days as you’re taking care of patients, or in my case, I spent most of my time in the mornings up until the afternoon in the maternity hospital as a urogynecologist and OBGYN. That was that was my primary placement. And we would have morning report every day with the residents and students, and the attendings or consultants as they’re also called. And the entire lecture hall would just shake, and that was one of the most surreal moments – that first morning report, looking out this window, and just seeing plumes of bomb smoke, and everyone just pauses for a second and then goes on and continues with the work at hand. And I feel like for me it was a month of dealing with this; and I could not imagine what it was like now 20 – 21 months of having to deal with this every single day, and hoping that one of the bombs didn’t hit your tent while you were sleeping. So that’s just sort of the setup of the security situation. But also at Nasser, you could tell in the first few days we got there, when we got these warnings to stay away from windows because there was gunfire and quadcopters and tanks literally rolling down the streets. The people who were already there, the medical staff, there was a real tension that was immediately felt because last year, if you may or may not recall, Nasser Hospital was invaded by the Israeli army. And not only was it invaded, it was desecrated and anything electronic was purposely destroyed. And I only saw firsthand, you know, I can really just speak from firsthand experience of what I saw and what my colleagues told me directly. But, everything electronic was destroyed. And it’s all in a warehouse now — ultrasound machines, incubators, ventilators, things to keep people alive were all destroyed. So everything that was in the hospital currently at Nasser was all replaced. Every room that the IDF went through, you could tell they had marked it with specific markings. So there were just marks on walls that were either in Arabic that were, you know — I don’t read Arabic, but from what I was told, they were a lot of curse words and, you know, bad things written and then symbols. But there was a real tension because at that time also at Nasser there were several dozen healthcare workers that were kidnapped. Some still in prison, some were released and came back to work the next day. There were tents outside because at the time it had been designated a safe zone. So there were people with IV poles and wheelchairs, and if you couldn’t evacuate because you were too vulnerable or couldn’t move because of you know leg burns, amputations, orthopedic fractures, bulldozers had just come through and buried everybody and they called it the graveyard. So there was this real tension in the air that this might happen again, and was going on in the first few days that we were there. After that, everything kind of stayed at that same level. And then the intensity of trauma that came in – because we were so close to these GHF aid zone sites, where people were getting shot and brought into the ERs and brought into the ORs. There was a real increase in casualty and morbidity and mortality that we saw that when I was there. And it was just by the numbers you could tell people were just completely overworked. Oh, and at the same time we had a several months of Israeli blockade and siege of any food aid coming in, any medical supplies coming in, any baby formula, diapers, you know, anything that you need to kind of survive and live was being blocked at the border. So that was an added element of stress, tension, fatigue that kind of was everywhere in the Gaza Strip.

Sam Seder: Can you I imagine you saw sort of two well you tell me, but imagine two broad categories of patients. I mean, the ones that you’re seeing in your role in the maternity ward and I wonder if you can speak to the condition broadly of of folks you saw in maternity wards and then the other cohort of casualties that came from like a direct conflict with the Israelis, you know, with the Israelis shooting them or we’ve heard reports reports of tanks firing at them, and like you say the quadcopters, and as opposed to the other cohort which may be dealing with deprivation and lack of sanitation, and all the other challenges that would go into both caring for children and you know prenatal care and I would imagine you know other children that you saw.

Dr. Ambereen Sleemi: Sure. My primary place that I worked again during the days was in the maternity, the hospital right next to the big Nasser. It was part of the Nasser complex, but it was just right next door. And so there you know we saw pregnant women who came in. and they were already dealing again with just stress bombing. Everybody is displaced into tents. So with pregnancy, what we saw was a direct effect of the lack of food and starvation that was happening as well as the lack of nutrients and prenatal vitamins and care. So all of these things led to, you know, pregnancies that were complicated because of these conditions. Dehydration is a big issue and that leads to another complication which is preterm births. So women who would come at term were already malnourished without the proper nutrients to sustain a pregnancy and sustain themselves. So we’d get women who physically looked starved and malnourished and then also the pregnancies because of the malnourishment the babies were restricted in growth and smaller for weight than they should have been. But then on top of that, you had an entire cohort of women who had complications from pre-term births. We know, you know, just I knew from my time there and looking at the statistics, that preterm births were up. Pregnancy complications like infections were up, preterm labor, premature rupture of membranes, those numbers were up percentage-wise. Congenital malformations or birth defects were also increasing. We also saw an increase in still birth and loss of pregnancy as well as loss of pregnancy at term or intrauterine fetal demise at term, where the baby or fetus dies at 9 months. And all of these things were increasing in number as a direct result of the blockade, the stress, the lack of clean water – all of these multifactorial things including environmental toxins from all the bombings. I mean clearly the air that we were breathing you could tell that there was there was toxins in it. It wasn’t clear, let alone you know how it affected the living conditions in tent. So all of these things added up to, you know, every pregnancy having some complication. So that’s the maternity side.

The other cohort is in the general operating rooms where when I was kind of done with my duties and it slowed down a little bit. I would go and help in the operating rooms with general surgeons, orthopedics, and plastics. So they really saw a lot of the trauma that we’ve heard about either coming from the aid sites the Gaza Humanitarian GHF or as we dubbed it the killing field sites where you know exactly as we’ve heard that’s what I saw when a mass casualty would come in from the sites it was almost like clockwork that there would be a lot of young men primarily because those are the ones that could carry a huge 25 pound bag of flour in their starved state back for their family. So gunshot wounds, shrapnel and then we also had people who were injured because of bombings at night in their tent. And then we have a very small cohort of people who were pregnant who were also bombed in the tents. And I feel like that’s something I got consulted for were women who were pregnant who had gunshot wounds and shrapnel. Women who were pregnant who were sleeping in their tent next to their husband with their toddler and they are six months pregnant and they’d come in with 40% burns and shrapnel all over their bodies. So those are the people that those are the women that you know again were sort of like where these intersected, right? And that was really horrifying and heartbreaking to see that on top of you know having a pregnant pregnancy and already stressed but being in a tent and either losing your husband, which one of the cases that we took care of a young woman who was 6 months pregnant sleeping with her husband and her three year-old toddler who you know had a bomb go off right near them in their tent and you know ending up with these severe burns that needed extensive surgeries, grafts, orthopedic intervention with bones lost and you know it’s just on top of that she has to sustain this pregnancy. Oh, and her husband died and the three-year-old also was hit with shrapnel and burns and is in the pediatric ICU. So you know it was it was all sorts of different scenario worst case scenarios that you could imagine.

Sam Seder: Was there over the course of those four weeks any way for you did you have any indication that the period of time I mean I imagine over the course of four weeks being without nutrition without food and medical supplies can exacerbate things significantly over the course of four weeks. Were you able to sort of clock that or was things basically consistent in terms of the the trauma that you saw or was it haphazard just as a function of what activity was going on within the south?

Dr. Ambereen Sleemi: I mean in my experience it seemed like every day things just got worse. When I left was the day the morning of the alleged ceasefire in certain zones to allow a few trucks in and airdrops. So that was the day that I was actually allowed out on Sunday. But up until that time it really felt like things had just deteriorated. And that was again just from personal experience of the bombs which we could feel and hear, the gunshots which always seemed to feel like they were getting closer, the number of mass casualties which never seemed to end. And also there was a point about a week before I left where the provider of food in our hospitals, the World Central Kitchen, ran out of food and stopped providing food for the staff as well as the patients. There was daily maybe one meal that was provided and that was what most patients would get would be like a small bowl of rice with some lentils or bread with something else. And that’s what the staff would get also. But you know the staff themselves after several months of deprivation of food and nutritious food, everybody just came in hungry. Everybody came in hungry and fatigued and you could just tell from their how they looked. I mean, people were very happy to show what they used to look like before, you know, even a year or so earlier. And everybody just staff, nursing, everybody, the doctors looked thinner and were definitely more fatigued. But you know, I have to say everybody showed up to work every single day that they were supposed to, did what they had to do. And never, you know, kind of never lost track of the site that they were there as clinicians and healers to take care of patients. And for that, I think that’s pretty incredible.

Sam Seder: It sounds amazing. I mean to have to go through this and maintain that sort of a level of dedication and did you have an opportunity to talk to patients or to their families? I mean did you have a sense of I mean I would imagine you you’re working near constantly and don’t have you know the time to sort of I don’t know take an anthropological assessment or a sociological assessment but was curious did you have any experiences with any of the people there who to get a sense of just I mean of I don’t know their disposition I mean I can only imagine, but I’m curious if there was any moments that you had that you found surprising in some way or maybe perhaps maybe sort of like sadly unsurprising.

Dr. Ambereen Sleemi: You know, I mean, I think we all have intimate relation with our and conversations with our patients that we take care of and round on and see daily. And I think everybody was just very tired of the bombing, tired of the siege, and really wanted peace, wanted the bombs to stop. And I heard again and again, we just want to live our lives, you know. So I feel like that’s the overarching message was that, you know, whatever you can do when you go back, try to try to, you know, demand a permanent ceasefire and end to the siege. You know, we were again, we were putting IVs in our colleagues that were fainting at work or getting sick on top of everything else. And I think everybody from, you know, staff to patients just really wanted to have an end to the constant bombing, the constant, you know, lack of food, the lack of water, and everything that they’d been suffering through for 21 months now.

Sam Seder: We played a clip, I think it was from, maybe it was yesterday or the day before from Dr. Nick Maynard. He’s a British surgeon. I know he worked at Nasser Hospital. I don’t know if you were familiar with him, but he claimed on BBC that they were confiscating baby formula. The Israelis were. What do you know about that story? Did you work with Maynard? Do do you have a sense where he was where he was getting that perspective?

Dr. Ambereen Sleemi: Yeah, absolutely. We overlapped by about two and a half weeks because we all stayed again we all stayed in a very specific part of the hospital where the volunteer doctors were staying in the accommodations. And yeah, so every night or in the morning we would have everybody was having the same conversations. We were given very rest rictive rules on what we could and could not bring in. So on one hand people might say well you should have just you know packed your suitcase full of you protein bars or whatever but you were really limited on what you could bring in and we all had heard from our colleagues who were there not too long before we got there that they had tried to bring in formula and it was confiscated. This we have heard anything when you were brought in you were scrutinized your suitcase was looked through and you could only bring in things for yourself. So we were asked to bring in food for ourselves for the time that we were allowed to be there and nothing more nothing less like that was it. So there was a very big fear of at least given the experience of our colleagues who had come through and tried to bring help for people that things were confiscated and so you know that was on everybody’s mind when you packed you know would I have loved of course I knew that there was a baby formula shortage but I also knew that they go through all your bag and check everything and would the Israelis would take it away and throw it.

Sam Seder: Okay. And would they provide any explanation? Was there any Did you guys hear of any explanation for that other than we just not going to allow baby formula into Gaza?

Dr. Ambereen Sleemi: Yeah.

Sam Seder: Are there any other things you think that people should know about your time there, what you saw? I mean, you know, I think we’ve spoken to, I think, at least, one or two other doctors over the course of the past 21 months who’ve been at Nasser Hospital and at various times it’s been, more horrific, than others. But consistently horrific over the course of those 21 months. But are there any things that you think that we should know that’s important for people to know about what’s going on there?

Dr. Ambereen Sleemi: You know besides what I’ve already spoken about I think one of the things is that as I left it was so bittersweet. And I’m sure your other guests would probably say that too if they’ve worked in the hospitals in Gaza. On one hand you’re happy to get home and on the other hand you are really concerned about I mean when I go back I don’t know which of my colleagues I’ll see again because there has been a consistent targeting of healthcare workers with you know bombs and gunshots and kidnappings and I think that that’s one of the things that I left with. Also you know we really need to do what we can as we’ve come back now to demand a permanent ceasefire, an end to the occupation, an end to the blockade, and allow the agencies that know how to distribute food without killing people who are trying to get food because they’re starved. Allow them to get back to the work that they were doing.

Sam Seder: Is just lastly, has your perspective on any of this changed by you know over the course of has your perspective on the US government on the Israeli government on what was going on in Gaza than maybe you may have had I don’t know 10 months ago, 21 months ago.

Dr. Ambereen Sleemi: Yeah. I mean, I thought I was pretty up to speed with things and I spoke with clinicians that had been there before. But nothing prepared me for seeing it firsthand, you know, to seeing human beings of all ages. You know, civilians just shot, burned, maimed. The amputations was something that I really was not prepared for in kids and adults. And so I think actually being there really opened my eyes and it made me concerned that people probably aren’t really aware of what’s happening as much as they could be. And I urge everyone to really make themselves aware. And I think if they knew that, you know, these bombs and all this that’s doing all this damage was affecting humans in this way, the citizens of Gaza in this way, and that it’s our taxpayers money that is paying for the bombs that is that burned, you know, this pregnant woman that’s paying for the bullets that are in these children or in these men that are trying to get food. I really would like to think that people would speak up a lot more and demand our government stop funding this.

Sam Seder: Dr. Ambereen Sleemi, thank you so much for your time today. Appreciate the work you were doing over there and thank you so much for coming and telling us about it. Really appreciate it. Very important obviously.

Dr. Ambereen Sleemi: Thank you so much.