During my two-week mission to Gaza in January, I traveled from my well-equipped hospital in Chicago to work in a multispecialty clinic in Rafah and a large hospital in Khan Younis about 6 miles north of the city. During my daily commute, I passed by an endless series of tents of all shapes and colors where families huddled together, lacking the necessities for a dignified existence. They had been displaced from different parts of Gaza, forced to flee by the Israeli army.
At our clinic in Rafah, I treated Sarah, 14, who was displaced from Gaza City’s Sheikh Radwan neighborhood, which was completely leveled by bombs and missiles. She misses her school and friends. She lives with her parents and five brothers and sisters in a small tent surrounded by hundreds of others. She dares not to go the washroom at night. There is one latrine for every 200 people in the camp. Sarah presented with jaundice, fatigue, fever, nausea and abdominal pain. After a thorough examination, she was diagnosed with hepatitis A and dehydration.
In the absence of laboratory tests to confirm the diagnosis, it felt as though I had been transported back to the Middle Ages, where diagnoses relied solely on pure clinical assessment. This is what the health care system looks like now due to the war and blockade. At that time, the World Health Organization reported approximately 8,000 cases of hepatitis A in Gaza, primarily due to water contamination from seeping sewage. Our medical team administered intravenous fluid therapy to Sarah. Her heart rate improved gradually. Additionally, we provided her family with 50 shekels to help acquire food during this challenging time. The following day, Sarah returned to the clinic accompanied by her parents, her face beaming with a big smile.
Rafah, whose pre-war population was 250,000, is the last refuge for 1.5 million Palestinians fleeing war and death. You can imagine the strain on the 25 square-mile city and its limited infrastructure. At the time I was there, there were only two functioning CT scanners, one birth center and three partially operating hospitals for 1.5 million people.
My organization, MedGlobal, provides health care services in disaster regions around the world, such as Ukraine, Syria, Bangladesh and Sudan, through our local teams and medical volunteers, including in Gaza since 2018. Our local team runs 10 clinics that serve about 4,000 patients every day. We also run the only clinic in Rafah that specializes in treating children suffering from malnutrition. Each day, our stabilization center provides specialized formulas and nutritious meals to about 30 children with acute malnutrition — a condition not witnessed in Gaza in modern times — which can cause irreversible harm to the physical and mental well-being of these children, significantly affecting their growth and development. Samantha Power, administrator for the United States Agency for International Development, and the World Food Program’s director, Cindy McCain, confirmed the reports of full-blown famine in Gaza.
The famine and staggering toll of civilian casualties in Gaza — more than 34,000 dead and counting, two-thirds of them women and children, and more than 75,000 injured, per the United Nations — threaten to be the most defining global crisis of our times.
With the ongoing Israeli incursion on eastern Rafah, the flow of humanitarian aid has been blocked by the military operation. My organization recently had to cancel our medical mission due the closure of the border crossing. Civilians have very limited evacuation options. Khan Younis to the north, destroyed by the latest assault, is uninhabitable; Deir Al-Balah, a small village in the central area, is already overcrowded; and there is no access to the north.
A full-scale assault would undermine all operations by the U.N. and nongovernmental organizations, and it would likely spark a border crisis, with civilians attempting to flee en masse through Egypt. The number of casualties would skyrocket. Thousands of lives would be lost, and many more people would be injured, with the majority being children and women, as we have witnessed in previous military operations. It should go without saying that this calamity would also be disastrous for the U.S. interests and our moral leadership.
Some may argue that President Joe Biden does not have a magic wand in Gaza. Yet many, including members of Congress I recently met with, have asserted that the president has leverage that he could bring to bear. On Wednesday, Biden demonstrated that by announcing that the U.S. would withhold certain weapons and artillery shells if Israel engages in a ground invasion of Rafah. This is a first step, and it should be applauded.
By conditioning further military aid to Israel, like other presidents have done, he could pressure all parties to impose an urgent and sustained cease-fire and head off what otherwise would be a bloodbath in Rafah, while leading at the diplomatic front for a release of the hostages and a Marshall Plan to rebuild Gaza.
In a recent meeting at the White House, my colleagues and I shared with Biden our firsthand accounts from recent medical missions in Gaza. He told us that he empathizes with the innocent victims in both Israel and Gaza and that he, the first lady and Vice President Kamala Harris are anguished by the horrors unfolding. He also mentioned that Rafah is a red line. We believe him.
Biden is fond of saying that the United States should “lead not only by the example of our power, but by the power of our example.”
Biden has the opportunity to change the dynamics in Gaza and the Middle East by taking cues from history and leverage all his powers. His legacy will be shaped by his decisions on Gaza.
He can stop the ongoing offensive in Rafah and the humanitarian catastrophe that it will undoubtedly unleash.
Dr. Zaher Sahloul is a critical care specialist, president of MedGlobal and former president of the Syrian American Medical Society. He has led medical missions to regions hit by natural and human-made disasters.
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