I’m a U.S. Surgeon in Gaza—There Was No Bleach to Treat a Woman’s Wounds

I am an American trauma surgeon. Two months ago, I was in Gaza volunteering in a healthcare system that is progressively collapsing. Now in the wake of Israel’s recent invasion of Rafah, I am even more concerned.

My lived experience highlights patients’ profound challenges amidst ongoing conflict and resource scarcity. Weeks before the beginning of the continuing Israeli offensive into Rafah, I worked day and night at one of the few operational hospitals in Gaza, where overcrowded wards, dwindling medical supplies, and frequent power outages threatened human health.

To assist, I was part of a collaborative effort between the World Health Organization (WHO) and several NGOs including my own, MedGlobal, to support health care delivery with additional staff.

Amidst the suffering, the story of Rowan, a young woman battling a life-threatening infection, epitomized the struggle for survival in overwhelming adversity.

Rowan was 20. Fifteen days before I arrived, she was run over in the night by an Israeli tank. Her family had moved down from the north and set up a tent in what—at the time—was a designated safe area between Rafah and the sea.

As the tent was crushed, most of the family passed between the tank’s tracks and were unhurt, but Rowan was maimed. Her leg was broken and her pelvis cracked, but the major injury was to the soft tissue on her left side. When run over, the shearing forces often separate the skin and fatty tissues from the underlying muscle. Such injuries are easily infected.

I met her during my first morning at the hospital. Her dressings were opened and a necrotizing or flesh-eating infection was apparent. This young adult needed major surgery to survive. I listened as the exhausted teams discussed who would take responsibility of this situation. What ended up being a limited procedure with some sedation was ultimately accepted. I expected her to be dead by the morning.

By the next morning, I had made friends with a visiting surgical team from Jordan. Together we decided to take Rowan, still alive and talking, to the operating room. We removed layers of infected tissue for the next two hours, eventually covering it all in gauze with plans to reassess the wound the following day.

With little breaks, I continued to operate. There was an old man crushed by a blown-up building who needed part of his stomach and intestine removed. There was a six-year-old girl with a shell fragment through the right side of her colon, whose abdomen I opened. But I kept thinking of Rowan.

The next morning, she was improving. We again removed more tissue and changed the less-pus-soaked dressings. The instruments we used, especially the scissors, were dull. I switched to scalpels. We thankfully had these tools, despite their general scarcity. With the years-long blockade of Gaza and the severe present restrictions on goods, every imaginable thing is rare.

Haphazardly, it went utterly dark in the operating room. The power grid had been destroyed and the hospital’s generator was glitchy. I started wearing a personal headlight during every surgery at all times of the day. Similarly, the precious fresh water supply to the operating room sinks occasionally stopped. When that happened, I scrubbed it with salt water.

Each day I again operated on Rowan, but the initial gains against the infection slipped. I began to suspect she had been infected by Pseudomonas—a soil-living bacteria that makes thick films on wounds and has a particular smell. It can be hard to treat.

A very basic strategy is using a weak chlorine solution known as Dakin’s. The ingredients are simple and include baking soda and bleach, but a day’s effort and dozens of conversations concluded that there was no bleach and probably no baking soda anywhere to be found.

Her wounds refused to heal, even in the minimally infected areas around the hip and flank. Human bodies need an overabundance of nutrition, especially protein, to heal large wounds. Even now, Gaza is starving. A tally of the food her family could provide was meager compared to the substantial need.

One night, I was up late working on an old man with a lime-sized hole blown out the back of his chest by a bullet. He needed a flap of muscle to keep the air from sucking in and out of the hole. Afterward, I stopped by to see Rowan.

In the dark room, she shared with many other patients on beds and mats, I climbed over sleeping bodies to the corner of the room where she stayed. I checked her—already, the dressings were soaked. However, we lacked the operating room space to change her dressings more than once daily.

For a while, I did not know how this story would end. The team of doctors was committed to helping Rowan through this injury. We eventually had high-level diplomatic support to move her to a burn center in Amman. The old man with the stomach injury died, and we were able to transfer Rowan to his ICU room, where we could do a dressing change in a genuine hospital bed twice a day.

But her sepsis worsened despite high-quality debridement and she ran out of her considerable reserves. In the end, her wounds flowed with seepage—there was too little protein in her starving body to hold the fluid inside. Doing what would be the final dressing change for this dying young woman—I had a vision: the white of the dressing gauze was becoming the white of a funeral shroud.

What was breathtakingly obvious to me was that for the many bombed, shot, and burned patients I cared for daily, the route back to health was profoundly impaired by deep deprivation. There was no bleach in Gaza to treat a woman’s wounds. With Rafah’s crossing no longer functioning, this deprivation will deepen.

Judah Slavkovsky MD is a trauma and acute care surgeon. He works and teaches in Urbana-Champaign, IL, and volunteered with the international NGO MedGlobal in Gaza in March.

All views expressed are the author’s own.

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