'From Gaza, with love, despite the pain' - US doctor recounts Rafah visit

Nimr Ikram, a Texas-based orthopaedic surgeon, recently spent two weeks in Gaza, providing medical aid to those in need.

The doctor worked with US-based humanitarian aid group MedGlobal to enter Rafah. He and his colleague Irfan Galaria, a Virginia-based plastic surgeon who recently described what was happening in Gaza as "not a war, but an annihilation," ended up sleeping at the hospital where they were treating patients to maximise their time.

In an interview with TRT World about his experience, Ikram explains how he grew accustomed to the sounds of bombs and drones, the heartbreak he felt treating orphaned children and the admirable resilience and dignity of the Palestinian people.

TRT World: Let's start with going into Gaza. You saw a whole line of aid trucks? Can you just tell us more about that?

Dr. Nimr Ikram: We flew into Cairo from here (Texas), and then from Cairo, we had a 14-hour journey because there were six different NGOs, and there were 30 of us, and multiple different checkpoints on the way — I think six to eight.

And so after the last checkpoint, we started going towards the border. And just for miles, you see an abundance of trucks. We had seen them even before the last checkpoint on the side, and thought that was the whole line.

But then we got to the checkpoint, got past the checkpoint, and started walking through and even then you saw hundreds more trucks just waiting on the side to be allowed to enter. Certainly there were perishable things in there, someone said that they saw a truck just full of eggs. And that didn't survive for that long so unfortunately, there's perishable and non-perishable items that are there that's just being wasted sitting there.

TRT World: So what were your first impressions when you went into Rafah? Is that where you were staying?

Dr. Nimr Khan: We entered into Gaza into Rafah, and MedGlobal and the World Health Organization and the United Nations had cleared us to come. It was interesting — before I had gone, I had signed up with a couple of other groups as well, and they're like, it's not safe, we're not going to send anyone.

So I was thinking, is MedGlobal safe? One of my friends had gone with them before. And he said, if there's any question, they won't allow you to go. So, Rafah was supposed to be a safe zone at that point. But even as we crossed the border, all of a sudden you hear some gunfire going on, and you hear some bombs in the distance and things of that sort.

So of course, the first time we go through, we're like, "Was that a bomb?" And the locals, they're like, "Oh, yeah, it's far away." Unfortunately, they are just immune to this stuff. And even after 10 days, it was the same thing with us. You hear something, it's kind of background noise, unless something happens right close to you.

And there were a couple of incidents that we had one up close to us. That was the only time that we were kind of, you know, oh, my God, is something going to happen to us?

TRT World: Did the World Health Organization and UN say that they were not responsible for your safety?

Dr. Nimr Ikram: Yeah, they say it's an active war zone. They're not ultimately responsible, you have to know there's a chance that you may get injured. But whenever we're travelling, we're supposed to contact someone (in an official capacity).

I think from their standpoint, they were in communication with the (Israeli military) and will get either a red light or a green light. Meaning, hey, it's okay to go so you have a green light or no, it's a red light, and right now, there may be some activity so you guys shouldn't go. So they tried to protect us as much as they could.

But even then, one time, we had a red light for about an hour and I was just working in the clinic and things and then we finally got the green light. So we started going to the hospital because one of our team members was an (intensive care unit) physician so she was working in the ICU at the hospital.

So we started going to the hospital and about a block away, a bomb goes off and we see the smoke. So as I said even though this is a red light, green light situation, and even if they say it's supposed to be a safe zone, unfortunately that happened. So we get to the hospital and all of a sudden the ambulance comes, the cars come with the people who have been hurt by this bomb.

TRT World: And which hospital were you in?

Dr. Nimr Ikram: Initially we were scheduled to go to al-Nasr Hospital but it was off limits. Israel has surrounded it and they took all the physicians out, they took all the patients out.

So then they sent us to another smaller hospital, al-Najjar. There weren't many cases there. And so the plastic surgeon who was with me, we wanted to be more useful, so then we asked, is there another big hospital that we can help out with? And so there was a European Gaza Hospital. So we ended up being at EGH, for I think about eight days.

It's on the border of Khan Younis and Rafah, so people are still coming there, even though they were kind of pushed south. They're still going to that hospital.

The European Gaza Hospital, I think they were kind of protected because the European Union did fund this hospital. So I thought for some reason, they may have been a little bit protected. But even then, like I said, when they were in the operating room, and at eight o'clock at night, and two bombs went off close to the hospital, the whole hospital shook. So even though we're supposed to be safe, there was no safety there.

TRT World: Regarding safe zones, and how there weren't any, can you speak a little bit about that?

Dr. Nimr Ikram: The whole Rafah at that point was supposed to be a safe zone. They weren't actively attacking it. But as we crossed the border, we heard gunfire going off, we heard bombs going off. As we're driving in Rafah, close to the hospital, the bomb that had gone off ended up being about a block away from us.

And you'd hear bombs going off every night, you hear drones overhead. And the drones, I was told that they could either drop bombs or had guns on them. Or they were just there for secret surveillance. But all night — the drones started at about probably 8pm. And went until about 8am.

TRT World: So you could go out before those times basically?

Dr. Nimr Ikram: Initially, they said there's a curfew there. That was one of the challenging things. MedGlobal actually supplied a house where you go back and forth to the hospital from the house. The issue was (surgery) didn't start until about 10:30 or 11am.

And then we had a curfew, we're supposed to go home by 6pm. They wanted us to pretty much leave the hospital by 4:30pm or 5pm to get back home. So the first day we did it. And then the third day, we're like, it doesn't make a whole lot of sense to go back and forth and work 11am to 4:30pm. And then be delayed for the green light and all that kind of stuff. So then me and the plastic surgeon decided for the last six days that we would just stay at the hospital.

TRT World: Most people tend to go away from conflict zones, and you kind of went into one. So can you talk a little bit about your rationale? What were you thinking going in? Why did you go?

Dr. Nimr Ikram: From my standpoint, and the things that I teach my kids is that we're always being tested. As a physician, we're well set, no major test and tribulation that we have. You see these people over in Gaza, and Africa, all these places, they don't have food, they don't have anything.

We've been blessed with so much. So I said whenever we get tested, we should kind of step up to the plate and try to do whatever we can.

I was supposed to go mid-February or March, but the trip was moved up to January. So as things were kind of falling into position, then I talked to my kids and my wife. We believe that our time is limited. And whenever we're supposed to go, we're going to go.

So we talked and said, is it better to go in Plano, Texas, or is it better to go doing humanitarian work for those who are less fortunate in Gaza? So we all agreed and I had full faith. Allah had chosen me to do this work. And so I figured he'll bring me back safe and sound. And he did.

TRT World: Speaking of children, can you speak about children being hit by sniper bullets?

Dr. Nimr Ikram: We didn't usually go down to the emergency room. But one of the team members was an ICU doctor. And so anything that came in that was possibly someone who could be saved and taken to the ICU, she was always called down. So it was probably like our fourth or fifth day there. And she said that a five-year-old and a seven-year-old child were brought into the emergency room, each one with one single bullet shot to the head.

The father was saying, "This is my only daughter, save her." Of course they asked what happened? And he said we were told that Israeli forces were pulling back. So we wanted to see if there's anything left over at our house, if there was anything else to go back to, so we started going back to our house, and there were who he assumed were snipers waiting for them.

And they took out the children. This was unfathomable. From a just a humane standpoint, who does that? How are you taught to kill a five-year-old and a seven-year-old who have nothing to do with any of the conflict that's going on here?

TRT World: You couldn't save them?

Dr. Nimr Ikram: There was no saving them, unfortunately. Even the work — I thought I would be doing a lot more, like I thought I'd be working 24/7.

But unfortunately, when the bombs are going off there, they're there to kill people. They're not there to maim them. So once a day, we'd have someone who was in a car or someone who was in a building who ended up losing a leg or something of that sort, and we had to do some amputations.

But otherwise, when we were in the emergency room, those six people who came who had been victims of the bomb, there was no saving them unfortunately.

TRT World: So as an orthopaedic surgeon you deal with broken bones right? With so few doctors, and so few medical resources, what's awaiting people who had amputations, because there's not much aftercare?

Dr. Nimr Ikram: Things that can't be salvaged, we can amputate them. But we try to save as much as we can. Actually, those patients are probably a little better off than the patients whom we do what's called an external fixator.

That is when you put two pins in one side of the bone that's broken and two pins on the other side that's broken, and you put a bar to kind of hold it to allow it to heal up. But the issue is, with the cleanliness there, and the lack of resources and the lack of even clean water, you have these pins that are sticking into the bone, but are exposed to the outside elements.

Those have a higher risk of getting infected and a risk of not healing up. So we tried to salvage them and bring them back every two days to wash out the wounds. But if you don't have proper hygiene, you don't have any clean water to clean it out with, if you don't have good nutrition — the body heals itself by being able to have good nutrition, vitamins, minerals, things that help heal your body up.

And these people are not getting food, a lot of them are malnourished. So even if we can hold the bones in position, because of the malnutrition, they may not heal up from that.

So sometimes doing an amputation is better in theory, because that will heal up and then we can put a prosthesis on that later on, like a fake leg, or maybe an arm or something of that sort to help in the long term.

TRT World: And what sticks out to you in terms of some of the most memorable moments you have there?

Dr. Nimr Ikram: So there were a couple. One is that one day, a five-year-old child was brought into the (al-Najjar) clinic by a man. And he had fallen, he had hurt his arm, he had hurt himself. I have four kids, so we just assumed it was his father, his brother. And we asked, so like, "Oh, what's your relationship to him?"

He's like, "Oh, I'm not related to him." And we were like, "What?" And he's like, "Yeah, I just saw him on the side of the road. So I brought him in to help." So we asked this five-year-old, "Do you have any family, where are your parents? He said, "Everyone's been killed. I'm by myself. "

So a five-year-old to me who has to take care of himself, and has to grow up like this without any kind of family left behind. That was a heartbreak.

I have kids, so I can't fathom a five-year-old having to fend for themselves and try to take care of themselves. But the other thing is the kids, the people there are so resilient. They're so thankful that we had come to try to do something for them.

They don't have anything that they can give, obviously. There's no gifts that they can give or anything of that sort. So what they do is they either get seashells because it's right on the beach, or they get rocks. And so what they'll give you as a gift — they give you either one of those and usually they write on it, "from Gaza with love, despite the pain."

It's amazing. The first time I had gotten it, I didn't know what it was. And so I went back to someone who spoke Arabic, and that's what they said, I mean, it brought tears to my eyes. These people have nothing, but they still have their dignity and their pride. And that's what they do. They are trying to still be very thankful for whatever we're doing for them.

TRT World: And when you have to when it's time to leave, what did it feel like to leave? Was that difficult, was it a relief, or both?

Dr. Nimr Ikram: Both. I went with the mindset that I'm going for good, and I'll be safe, but in the back of your mind, you obviously hear these bombs going off. I wasn't scared, but at the same point, I knew that something could happen to me. And we were there for 13 days in total. And so we felt guilty multiple times. So we were in the hospital, and they'd bring food for all the staff members who're working — the doctors, the staff, the nurses, everyone there.

And we just felt terrible. Even thinking of taking any kind of food — so many people in the hospital were there for shelter, and we said, give them the food. We had brought our own supplies, protein bars, enough to get us through.

There's a plastic surgeon who was pretty much on call 24/7. And so he works six days a week from 10am to 10pm. The last day that I was there, I actually got done early in the OR, and the surgeon asked me to stay longer in case there was an orthopaedic emergency.

These people can't go. And for us, we're able to just come back to America and live normally. Literally, when we just crossed over into Egypt, it was just surreal. Did we do this — was it a dream that we were in, because now we're in Egypt, we're safe.

Now we don't have any worries in the world. And in this day and age, how can this be going on? And people are allowing it to happen? That's really hard.

TRT World: Do you have a call to action for anyone reading this and wanting to know more how they can help?

Dr. Nimr Ikram: Obviously, as a physician, I know there are multiple groups now that are planning on going to Gaza. MedGlobal is taking groups every two to three weeks. That's the one thing that you can do.

Maybe most importantly, the main thing is to have a ceasefire, and to allow aid in, but even then, there's a lot of rebuilding that needs to be done. We're trying to figure out with these other groups, because a lot of people want to help and are willing to help and can help in the rebuilding.

People can reach out to me. I'm trying to figure out how we can help the rebuilding process, because everything's annihilated, unfortunately. So again, houses need to be rebuilt, or the hospital needs to be rebuilt. There's a lot of that that needs to be done. If we can work on trying to figure out how to do that long-term that will be best.