A Clinical, Ethical, and Human Call from Al-Shifa
Collective Chronicle from the Epicenter of Gaza’s Health Crisis
“I can’t go on”
“It was like a ‘March 11’ every single day,” repeats Dr. Raúl Incertis, a Spanish anesthesiologist recently returned from Gaza, his voice faltering. During his volunteer work at Naser Hospital—one of the main medical centers in the south of the Strip—he witnessed the full scale of the humanitarian and medical disaster.
“There was no anesthesia, only intravenous ibuprofen to relieve the pain. We operated with the bare minimum, in the midst of absolute chaos,” he recounts. “I saw colleagues die; I lost count of the children with gunshot wounds to the head and chest; mental exhaustion was consuming me. Upon waking, my first thought was, ‘I can’t go on.’ My mind felt sealed shut just to keep going.”
The violence and destruction were so intense that he described the setting as a “House of Horrors,” a term coined by professionals who have lived and worked in those collapsed, debris-filled corridors.
Returning to Spain was bittersweet: “Being there was like living in hell; coming back was like waking up in paradise, but I am no longer the same.” His testimony is the recent, human face of an ongoing tragedy.
I. Collapse: Between Emotion and Ethics
Nothing prepares a physician for the daily disaster that is life in Al-Shifa. Here, the noise never stops, death does not wait, and emotion is an open wound. Confronted with torn bodies, impossible decisions, and scarce resources, the only refuge left is ethics.
What does it mean to heal when pain is inevitable and life is a fragile privilege?
In these destroyed corridors, emotion becomes the first form of resistance, and ethics the final pillar holding everything in place.
II. Absolute Scarcity: Medicine on the Brink
The hospital inventory reflects not what is present, but what is missing—always the essentials:
- Anesthesia and analgesia:
No ketamine, no essential opioids. Surgeries are performed with intravenous ibuprofen, grossly inadequate for acute pain. - Antibiotics:
No carbapenems, no glycopeptides, no third-generation cephalosporins. Severe infections are a death sentence. - Fluids and electrolytes:
Normal saline is a luxury. Oral rehydration is improvised with water, salt, and sugar—if available. - Oxygen:
Cylinders empty faster than they arrive. Manual ventilation replaces inoperative ventilators, further exhausting staff. - Surgical and wound care supplies:
Gauze is washed and reused. Sutures are sterilized under precarious conditions. Gloves are rationed. Antisepsis is relegated to an ideal. - Blood products:
The blood bank is collapsed. Potential donors are malnourished or dehydrated and cannot donate.
In sum: medical practice here consists of improvisation, endurance, and triage—always operating far below any international standard.
III. Clinical Reality Under Siege
Diseases and complications mirror the structural deprivation:
- Severe infections such as sepsis and gas gangrene from wounds that cannot be adequately cleaned or treated with modern antibiotics.
- Diarrheal diseases, dysentery, and cholera risk due to the lack of potable water.
- Severe pediatric malnutrition, refeeding syndrome in children with no nutritional support.
- Dermatoses, scabies, and impetigo from overcrowding and lack of basic hygiene.
- Pneumonias from prolonged manual ventilation.
Medical technique collapses into moral triage: who can be saved, and how does one allocate the impossible?
IV. The Impossible Shift: Daily Ethical Dilemmas
Routine at Al-Shifa is a succession of extreme decisions:
- Hemorrhage: Controlled with tourniquets and direct pressure; hemostatic agents are rare and precious.
- Debridement: Optimal cleaning yields to repeated washing with boiled water—if available.
- Open fractures: Simple external fixations; empirical antibiotics (when they exist).
- Abdominal surgery: Damage control as the rule; often leaving patients with ostomies when reconstruction is impossible.
- Analgesia: If available, regional blocks are attempted, but most often only companionship and a voice remain.
- Malnutrition: F-75/F-100 formulas absent; improvisation replaces clinical protocols, with minimal supervision.
Every act is an ethical sacrifice and an unspoken promise not to abandon, despite the impossible.
V. The Invisible Dimension: Mental Health and Professional Burnout
Post-traumatic stress and compassion fatigue are not statistics here; they are eyes that no longer focus, trembling hands, sleepless nights, and a pain barely audible in the voices of those who keep going day after day. Local staff—many grieving family members or enduring trauma themselves—survive on hunger and fear, yet continue to work. As Dr. Incertis puts it: “Everyone is burned out and depressed, most with symptoms of PTSD.”
Persistence is a secret, stubborn form of resistance.
VI. Ethics in Ruins: Medicine as a Human and Political Act
To practice medicine in Al-Shifa is to enact ethics in real time. Each decision is a moral and political act. The banality of evil, in Hannah Arendt’s terms, reveals itself here in the normalization of suffering and the world’s indifference.
Healthcare workers are not merely technicians; they are guardians of dignity. That daily gesture defies a reality upheld by political complicity and global silence.
VII. International Humanitarian Law and Its Breach
International Humanitarian Law and the Geneva Conventions guarantee absolute protection for hospitals, medical staff, and patients in armed conflict, including the right to supplies and the prohibition of attacks and interference.
In Gaza, these protections are systematically violated, placing lives dependent on medical care and ethical aid in daily jeopardy.
VIII. Proposals for Action
- Urgent international pressure to ensure safe, sustained entry of medical supplies.
- Comprehensive protection and psychological support for healthcare workers.
- Ethical and humanist education from the outset of medical training, using real cases.
- Ongoing monitoring and denunciation, with documentation and public engagement.
- Promotion of critical empathy and public mobilization to transform indifference into commitment.
IX. With Albert Schweitzer: A Human Model of Resistance and Service
Albert Schweitzer (1875–1965), physician, theologian, and philosopher, Nobel Peace Prize laureate in 1952, left Europe in 1913 to found a hospital in Lambaréné, Gabon, primarily treating leprosy patients under rudimentary conditions. His ethic of “reverence for life” held that all human life, especially in suffering, merits respect and care.
His example shows that medical commitment can transcend professional duty and connect with a profound existential and ethical calling in the face of suffering.
X. Closing: From Testimony to the Questions That Must Not Be Avoided
The account of Dr. Raúl Incertis and those who lived the House of Horrors is not merely a report—it is an urgent summons to confront the human and the ethical.
After witnessing surgeries performed with ibuprofen, oxygen improvised with human lungs, boiled water replacing saline, and dignity holding out until the last breath—one must face questions that must not be avoided:
- What drives a physician to stay when “there is nothing left to do”?
Is it only the Hippocratic Oath, or something deeper—anthropologically basic—that binds us as a species? - How do patients and adults endure under genocide and near-total destruction?
What sustains their bodies and souls when everything is gone? - What is the ethical meaning of practicing medicine without resources or technical hope?
Does this redefine the very purpose of medicine? - To what extent does the banality of evil manifest here, in the normalization of suffering and abandonment? How can complicity by omission be avoided?
- Does medical duty end with the possible treatments, or does another form of accompaniment begin when technical options are gone?
- What does it mean to stay when everything collapses?
When all resources are depleted, when infrastructure is 95% destroyed, when supplies are trampled underfoot by those who despise life—does one leave? Abandon a hospital full of patients and walk away? Or does one remain, as Albert Schweitzer did in his leprosy hospital, resisting not by mandate but by that essential bond that constitutes us as humanity?
The essential question lingers like an echo:
Does duty end… or begin anew when it seems there is nothing more to be done?
These questions mark the threshold for future essays, debates, and actions demanded by this tragedy. And no one is entitled to evade them.
Brief Glossary
- Triage: Medical process of selecting and prioritizing patients according to urgency and available resources.
- Banality of evil: Philosophical concept (Hannah Arendt) in which horror becomes everyday and acceptable through normalization and indifference.
- International Humanitarian Law: International norms aimed at protecting civilians and medical personnel during armed conflict.
- Compassion fatigue: Extreme emotional stress caused by continuous exposure to the suffering of others.
- Reverence for life: Ethical philosophy of Albert Schweitzer, centered on sacred respect for all life under all circumstances.
References (Vancouver style)
- World Health Organization (WHO). Health response to the crisis in Gaza. Geneva: WHO; 2023.
- International Committee of the Red Cross (ICRC). The norms of International Humanitarian Law and the medical mission in conflict zones. Geneva: ICRC; 2015.
- United Nations. Report on protection of civilians and hospitals in armed conflicts. New York: United Nations; 2023.
- Incertis R. Interview and personal testimony on the situation in Gaza. El País [Internet]. 2025 [cited 2025 Aug 8]; Available from: [recognized outlet].
- Schweitzer A. Out of My Life and Thought: An Autobiography. New York: Henry Holt and Company; 1933.
- Arendt H. Eichmann in Jerusalem: A Report on the Banality of Evil. New York: Viking Press; 1963.
- Frankl VE. Man’s Search for Meaning. Boston: Beacon Press; 2006.
- International Committee of the Red Cross (ICRC). Geneva Conventions and Additional Protocols. Geneva: ICRC; 1949.
