As a medical intern in Gaza, I have stepped out of the classroom and onto the front line

As Gaza entered its fourth month of the escalation of violence by Israeli forces, I was just a few months into my medical intern year—treating children with bomb blast injuries. In one case, I conducted the primary survey and inserted a chest tube on a child, but nurses couldn’t get intravenous access. They asked me to insert a central line, something I’d never done on a child so young. I hesitated, hoping for someone with more experience, but there was no one. Sadly, the child did not survive. As a medical intern, I should have been learning to provide care in controlled settings. Instead, I have been haunted by the many cases in which I did not have the training or resources to provide the care that was needed.

In Palestine, a medical internship is a year-long training programme for doctors who have recently graduated from medical school. They rotate through various specialties under close supervision. With little clinical exposure, interns don’t hold a licence to practise medicine independently, so a senior physician is needed to approve their decisions and orders.

Since 7 October, attacks on people and infrastructure have upended the supervision and training of graduate doctors and the broader healthcare system. Mass casualties, loss of medical personnel, and infrastructure damage have overwhelmed Gaza’s health system, which was already fragile. Recent medical graduates like me have struggled to fill the gaps caused by loss of more qualified medical personnel. We have been using emergency medical licences that have allowed us to take on frontline roles. At al-Aqsa hospital, recent graduates were the only doctors available to treat injured people in the emergency department, 18 hours a day, for months.

Even though I only graduated in July 2023, I have found myself working in the general surgery department undertaking complex surgeries. Instead of starting with minor operations, I immediately encountered injuries far beyond what I had been exposed to at medical school: open chest wounds with the heart exposed, 100% body burns, eviscerated organs, and patients with all four limbs amputated. Despite not having been trained in the steps of standard operations in a controlled environment, I did my best to save the lives of severely injured patients. I often knew that better care or resources would have made a difference, but these were not available due to Israeli military blockades.

Early in my intern year, a patient arrived in the emergency department with a large piece of shrapnel lodged in their chest. They needed emergency surgery, but the operating rooms were full. After struggling to keep the patient alive for two hours on my own they went into cardiac arrest. With cardiopulmonary resuscitation ongoing, we rushed into an operating room that hadn’t yet been cleaned. I assisted the surgeon with the resuscitative thoracotomy, with no gowns or drapes, in a non-sterile room where a fly buzzed around, persistently finding its way into our operative field. We managed to regain a pulse and repaired the injury to the subclavian artery, but the patient later died in the intensive care unit. This was my first experience as an assistant surgeon for a resuscitative thoracotomy, but I have since lost count of how many of these procedures I’ve been involved in. I had no choice but to help however I could, as no other surgical personnel were available because of the continuous attacks on hospitals and healthcare workers since the beginning of the escalation.12

Returning home wasn’t any easier. Basic necessities such as clean water, healthy food, proper clothes, and shelter were inaccessible. I was displaced, seeking safety at least six times, each time relocating to a different place. There’s also a sense of abandonment by humanity. One of my family members always recited, “Life here is survival, not living.” If you walk down bombarded Gaza streets, you’ll see graffiti over the rubble saying, “The dead are the lucky ones, their pain is relieved.”

This wasn’t limited to just my experience; it was shared by many graduates and medical students. I often wondered if I could continue working in an environment where death, pain, and uncertainty are constants. I felt calmer handling cases as time passed and responded faster, but the guilt and uncertainty remained. Every case was different, unpredictable, and without guidance; each decision felt like a test that I wasn’t prepared to take alone. The impact of these events stays with me; my mind replays every moment when I try to sleep. Even after the ceasefire took effect, I continue to carry the distress of each experience. Although there is now a brief sense of relief [with the ceasefire in place], I still wonder if anything could ever return to how it was before.

I had no guide for this life, only what I had learnt, seen, or could remember. It was a relentless cycle of improvisation, survival, and the hope that I could make a difference for the next patient.