Krystal Ball: We are extraordinarily fortunate to be joined by a remarkable guest this morning. Dr. Mhoira Leng is a palliative care doctor. She just recently returned from Gaza where she visited many places including Al-Najjar hospital, which is in Rafah. Obviously it’s very relevant given the ground invasion that just began in Rafah. Dr. Leng, welcome. It’s great to have you.

Dr. Mhoira Leng: Thank you. It’s great to be here.

Krystal Ball: Yeah. So first just tell us the context in which you were in Gaza and a little bit of what you saw there.

Dr. Mhoira Leng: Sure. I’ve had the privilege, incredible privilege of traveling to Gaza for 10 years and working with colleagues in hospitals, in universities, and this particular visit I was able to see what was happening to people who are living with illnesses such as cancer, kidney disease, heart disease, and to visit the colleagues and healthcare colleagues who are taking care of them. We were looking particularly, for example, at pain relief. And pain relief has been almost zero in Gaza during this last period. And I spent time, yes, in Al-Najjar hospital, in Fatima Al-Zahra hospital. That’s the oncology service that has been displaced three times already, and as well as neonatal hospitals and primary care hospitals in Rafah.

Saagar Enjeti: Doctor, what can you tell us about some of the remaining healthcare facilities? You’re talking there about the reduction in pain medicine and others. We hear about the destruction of the infrastructure. What was it like to actually witness firsthand?

Dr. Mhoira Leng: Yeah. I mean, number one, it’s an absolute privilege always to spend time with colleagues in Gaza, and some of the most inspirational, courageous and compassionate people that I know. The first thing that struck me was that the healthcare colleagues were utterly and completely exhausted. They had been working under these conditions for six months. They had been displaced personally and professionally. Every time their hospital displaced, you lose what little supplies you’d built up. And they had not been paid any salary for six months. The price of basic foodstuffs was sky high, making it impossible for their families. They were not sleeping any night. I was not sleeping any night, continually all night, drones and bombs. And yet they were still coming to work and doing the best they could. So that’s the first thing I’d say. And it was a pleasure to see people that I’ve known. I’ve taught in the medical school so you know, some of the young doctors – would you believe I was teaching communication and ethics just last August. And that brought up many a conversation about what ethics looked like in healthcare. But it was a pleasure to see people doing their utmost best. But I couldn’t believe how exhausted they were. There was a little bit of teasing about how much weight everybody had lost. But the reality was minimum 15 to 20 kilograms and that was in a place that had some access to food. I was only able to be in telephone contact with those in the north. So that’s my first thing that struck me. The second is everywhere was full. The hospital, Al-Najjar, a small district hospital. Over the years, Rafah has said, you know, give us a big hospital. But there was a big hospital just a few miles up the road in Khan Yunis and then the major one obviously in North Gaza. That hospital should have had 60 beds. It had anything between 600, 700 patients coming through the hospital and even more than a thousand in the accident and emergency. It was the first point of call for trauma, even though it only had a simple x-ray machine, and some ultrasound now. In fact, the doctors told me they felt they were working with their hands tied behind their back. And they told me stories of young people with diabetes coming in with very dangerous blood tests, something called blood potassium, very, very low. It’s a known complication, yet they couldn’t test for that. And so the patient should have been in ICU, should have had blood tests all the time. They were still managing to care for those patients. And one young doctor told me how he slept for 48 hours next to the bed of a young man his age who was dying of diabetic ketoacidosis. That’s this complication of diabetes, and actually managed somehow to help that patient survive. So exhausted healthcare staff, dreadful, dreadful circumstances, patients in huge trouble with their chronic illness and then their new illness such as a pneumonia or an infection, and then maybe also a traumatic event with an injury. So all of those combined and still people trying to care with compassion.

Krystal Ball: Wow. Doctor, you talked about how there was basically no pain management, which, you know, sounds very, I guess sanitized when you say it. If you are a patient who is suffering from a traumatic injury, if you are struggling with aggressive cancer, what does that actually look like and what does it look like to try to care for these individuals who are in absolutely excruciating pain? Because we’ve all seen the reports of even children having to undergo amputations with no anesthetic, women having to have cesareans with no anesthetic.

Dr. Mhoira Leng: Yeah. Thank you for that question. And I want to put it in the context that globally this is a big issue. I’ve spent 30 years of my professional career with other brilliant colleagues trying to work on this issue because this is a problem in many places. But when you’re in this kind of situation, it is unbelievable, the level of suffering. Just imagine the healthcare workers doing these procedures without anesthetic, the children, the mothers with cesarean sections without anesthetic or with minimal, or you get maybe one dose of a painkiller because that’s all there is, but nothing afterwards. Think of rehabilitating from your severe injury, all the dressing changes. Think of the burns patients. You know, I spoke to some of my colleagues whose parents died of severe burns and they watched them cry as they died. And this is no criticism of my colleagues. And then you move to the cancer. I just had the privilege of working with my Gaza colleagues to train 20 amazing multidisciplinary Gaza colleagues in pain and palliative care. They have the skills. We were about to graduate them. They were pharmacists and doctors and physios and nurses. And they were saying, you gave us the skill and we can’t use it. And the the stories they told of the cancer patients, children as well as adults, just crying, crying in pain, was absolutely devastating. I have to say the day we were there, they had got a small donation through UNICEF had arrived in Fatima Al-Zahra. That was the clinic for the oncology hospital, beautiful oncology hospital called the Turkish-Palestine Friendship Hospital in Northern Gaza that had been displaced now three times. And they got some and immediately my colleagues were coming to me and saying, you know, we know how to do this. Let’s get on and do this. But they also told me that every time they were displaced, they usually lost all their supplies. And yesterday that clinic was displaced again and I have no idea where they’ve been displaced to. I mean, where can they be displaced to? Will it even have a drop of analgesia? And it’s absolutely heartbreaking and unimaginable suffering.

Saagar Enjeti: Yeah. Doctor, what you mention there, the weight loss, just to translate for our US audience, that’s about 33 to 44 pounds that you’re describing, in terms of that. We’ve heard a lot here about the destructive effect of famine and the lack of aid. What did you witness with respect to famine and also to the lack of humanitarian aid being allowed into the strip?

Dr. Mhoira Leng: Absolutely. As you come into Rafah through across the Sinai desert, the first thing you see, that’s the crossing from Egypt into Gaza, the south, the first thing you see is queues and queues and queues of trucks. And I have to say my heart sank and I had a deep sense of shame that – humanitarian access to humanitarian aid is a basic right. It’s enshrined in international law and it was awful to see that. What we saw in Rafah at that point was people somehow getting by. I mean, a kilo of chicken or two kilos of chicken they hadn’t had any for a month. Some arrived frozen from Egypt and I think it was $50 or $60 to buy enough for a family. And remember I said no one had been paid. So they were somehow managing. There was a few tins coming in, and people were getting by but were still losing weight. And of course once you start losing below a certain level, you’re using up all of your protein stores. You become liable to infections. I saw people dying of pressure sores. Now that’s a combination of untreated wounds, of not enough water, no hygiene, because you’re living in circumstances where there is either no toilet facilities or one shared between hundreds. Can you imagine the hygiene? It’s getting hot now. That kind of infections were rising. That’s a result of malnutrition. But even worse, I was hearing from northern Gaza. I had two long calls with a very dear colleague I’ve worked with a long time. A tomato was costing $7. People were dying trying to catch the the food coming from the sky. I think you’ve seen reports on that. And all of this is one hour from where I used to come into Gaza, the Erez crossing. So, you know, it’s not like an earthquake in a distant mountainous place. This is just beside where food and water are available. And I also attended the meeting where we got an update on the nutritional status. And there’s four stages before you get to famine and each of those stages had been crossed and crossed. And now we were looking at moving in Northern Gaza fully into famine. And that is not severe malnourishment. That is imminent death of thousands. And it hardly ever happens. We see malnutrition, but a manmade famine is almost unheard of.

Krystal Ball: Dr. Leng, we covered this morning how the ground invasion long threatened of Rafah has begun, along with air strikes. The IDF has taken control of the Palestinian side of the border, has shut that crossing with Egypt there in Rafah. You know, as someone who has been in Rafah, when you hear that news, when you see those images, what does that mean to you?

Dr. Mhoira Leng: Yeah. I mean, there wasn’t a lot of sleep last night. Obviously we were communicating, trying to find out who was okay, where people were, what had happened. The very house that I was living in while I was there with colleagues has been evacuated. While I was there, there were bombs killing people in the house next door. And of course we remember the very public, well publicized, deaths, killings of World Central Kitchen staff. I mean, what I was hearing last night was just absolute panic. No one had fuel. They knew this might happen but they had nowhere to go. They’re trying to get out the way. Where can they go? They say they’re moving for peace, but there’s nowhere to go. There’s nowhere safe to go. And people are just trying to desperately find a way to survive. I spoke to a colleague in Northern Gaza, a very dear colleague working through the whole of this time. And he said to me, “Dear Mhoira, I’m so happy to hear you’re in Gaza, but we have lost hope in the international community and our people are simply awaiting our fate.” And that’s the sense I had last night. Number one, where is the international community to protect civilians, to protect healthcare, to protect the children and the sick? And also where is the humanity? I see humanity every time I go to Gaza and I’ve described already what I’ve seen. But I felt a deep sense of shame that as an international community we have not upheld the dignity and humanity of the Gaza people.

Krystal Ball: Dr., last question that I have for you is, you know, the healthcare system has been under attack routinely by the IDF. Some of the justification that’s been used in the context of Al-Shifa and other hospitals has been that these have been places where Hamas has been sheltering. Understanding that you were not in all places at all times, et cetera, I just wanted to ask you if you saw any evidence that would lead you to believe that there were Hamas operatives in any of the hospitals where you were.

Dr. Mhoira Leng: Thank you. Absolutely not. I saw no evidence in 10 years and all the hospitals that have been mentioned in news reports, particularly Al-Shifa hospital was a hospital I knew well. The senior colleagues that have been detained, I knew well. And can I just mention the courage of my Gaza colleagues? They’re still going to work even when they know if that hospital is overrun, they will be detained. And we’re hearing very, very serious, disturbing eyewitness reports of of torture on detainees, particularly for doctors. So I saw absolutely none of that. I only saw, I didn’t see any military presence at all. And I there has not been any credible evidence shared. And I would really again say we need independent journalism. We need independent international colleagues who can investigate and look into any of those allegations. But also can document which, according to the evidence presented to the International Criminal Courts, are evidence of war crimes.

Saagar Enjeti: Got it. Well, thank you very much, doctor. Uh, you’re a very courageous woman and we appreciate your time very much. Thank you.

Krystal Ball: Thank you, doctor. Thank you so much for everything you’ve done. It’s truly extraordinary.

Dr. Mhoira Leng: Thank you.