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Six months till this moment: Report from Gaza City, Dr Khamis Elessi

Cairdeas
15th April 2024

This blog post was shared as an audio message by the Cairdeas lead in Gaza, Dr Khamis Elessi. This is his message that he would like to share with all peace-loving people worldwide.

Hello, my dear friends, all of you, ladies and gentlemen. This is Dr Khamis Elessi, speaking to you from Gaza City. I have been living here in Gaza City since I was born here, but never in my whole life that I have seen something like this. 

Not even my parents, not even my friends, not even senior people have ever seen something that we are experiencing at the moment. Since six months, to the moment, Gaza strip has been subjected to the most brutal, barbaric, relentless attacks from air, land, and sea from the Israeli forces. 

Six months till this moment, 2.4 million Palestinians, who are being stranded for the last seventeen years in Gaza Strip under strict Israeli siege, have been subjected to the most brutal killing machines ever been witnessed in the last 200 years, more than what has been seen in World War II. Since six months till this moment, 2.4 million Palestinians have been forced to evacuate their homes at least six to eight times, evacuate their shelters, or the remaining parts of their shelters. Since six months till this moment, 2.4 million Palestinians have been subjected to the most moral and the most mental pressure ever experienced worldwide because of the intensity of the bombardment, because the amount of bombs dropped on every metre of Gaza Strip. 

Gaza Strip has witnessed relentless attacks, 24/7, 24 hours, seven days a week, leaving more than 33,000 Palestinians killed, leaving more than 75,000 Palestinians injured. The vast majority of them are women and children, seventy-five percent women and children, and the remaining of them are elderly people or people engaged in fighting. The rest, the vast majority of Palestinians who were killed or injured do not have anything to do with fighting or with militance. Unfortunately, since six months till this moment, more than 80,000 Palestinian homes have been demolished completely and more than 300,000 have been damaged partially or mildly. 

Over the last six months, more than 30 hospitals, out of the 36 hospitals all over Gaza Strip, has been made non-functional, uncapable of providing any sort of medical care for patients, and more than two million Palestinians are unable to access any healthcare of any type in their local residence. Since six months until this moment, more than 400 healthcare professionals have been killed, including doctors, nurses, physiotherapists, and aid workers. 

Since six months till this moment, more than 160 journalist have been shot dead, more than 140 UNRWA staff, United Nations staff, has been killed as well. In addition to the bombardment, to the military onslaught on Gaza, there was a new weapon used on people who remained in Gaza City, which is starvation, starvation war. 

So since three months till this moment, Gaza and the northern part of Gaza have been subjected to the most brutal starvation techniques, leading to famine among children and elderly, especially the fragile population and the marginalised population. So people were forced to eat cow’s feed, which is the only thing available on the market and if, if they still have the money to but it. 
Unfortunately, prices have risen by twenty times, thirty times, forty times sometimes. So leading, just to give you one example, flour before the war cost one-third of a dollar, and now one kilo of flour costs $35, so that means 1,000% times increase in the price of flour, almost 500% increase in the price of rice, almost 300% increase in the price of other things. And name it, everything has increased between twenty times and 100 times the original price, and people here are running very low on money, so they could barely afford to buy food or buy anything, especially those who are not employed by Ramallah government, or Gaza government, or UNRWA, or United Nations, or international staff. 

So those are left behind with no money and no food, starving, and we have witnessed so far the documented death of 28 Palestinian children who died of starvation and dehydration. What we need now? We need to stop this onslaught and we need to go back to peace and order, because peace is the only way that Palestinians and Israelis and Americans and British can survive on this earth, like brothers and sisters. And we need to bring medicines to those in need, especially patients with cancer, patients with chronic illnesses. 

Imagine I’ve been helping at Al Shifa [since this recording this whole medical complex has been completely destroyed] and we’ve treated lots of children. Massive burns, that I have never seen before and without even morphine, and we know that those kids are going to die today or tomorrow because of the intensity and massive spread of burns all over their bodies and the depth of that burn. But unfortunately, even though we know they are going to die, they die in severe agony; so we do not have morphine, we do not have any strong analgesics to provide to them to alleviate their pain and suffering. And if they are going to die, there is no place for them to die because their families were kicked out of their homes many times, and their homes were burned so that they make sure that when they come back to their homes, they will find no home to stay in. 

This is the strategy that they kick them from their homes, they burn their homes, so that they will be forced not to come back anymore to their homes or remain in places. Roads have been uprooted from their places so no ambulance can reach for the injured patients. Hospitals have been damaged, drugs have been banned, food has been banned. Electricity has been cut, communication has been cut, telephone communication has been cut. So, it is an intentional way of killing as many Palestinians as they can in the shortest time period while the world is watching. 

Gratefully, the world is starting to wake up and see these massacres and they are calling for ceasefire, immediate ceasefire. But unfortunately the Israeli side is not stopping the killing machines all over Gaza Strip. And we hope that you and many free people worldwide, many peace-loving people worldwide, will act immediately to stop this onslaught on Gaza Strip and to open borders, and to allow Palestinians, women, children, girls, to live as equal as other international people in their countries. In peace, in order with neighbours, and in peace and in order with everyone worldwide. 

Six months till this moment: Report from Gaza City, Dr Khamis Elessi

Dr Mhoira Leng and Dr Khamis Elessi in Gaza in March 2023.

Six months till this moment: Report from Gaza City, Dr Khamis Elessi

A picture taken in Northern Gaza by Dr Mhoira Leng before the war.

Six months till this moment: Report from Gaza City, Dr Khamis Elessi

Comparison of the damage: the same above mosque, before and after this war.

Six months till this moment: Report from Gaza City, Dr Khamis Elessi

Al Shifa hospital in ruins.

Six months till this moment: Report from Gaza City, Dr Khamis Elessi

Happier times, when the Rantisi Hospital was operational in Gaza; the peadiatric unit with Dr Khamis Elessi.

Six months till this moment: Report from Gaza City, Dr Khamis Elessi

Dr Khamis Elessi with Dr Amjad Eleiwa during one of the Professional Diploma in Palliative Care activities.

Six months till this moment: Report from Gaza City, Dr Khamis Elessi

Dr Mhoira Leng with some of Dr Khamis Elessi's family last year. They are all in Gaza at this moment.

Reflection on Advocacy with WHO for Non Communicable Disease in Emergencies

Dr Mhoira Leng
11th April 2024

Non communicable diseases (NCDs) and emergencies are an area that can take a back seat when humanitarian emergencies occur. During such emergencies, the focus is on rescue and management of injuries. Yet we also know that the toll from illness such as heart attacks, strokes, lung problems, cancer, diabetes, and kidney disease will dramatically rise in an emergency where stress is everywhere and access to health care and essential medicines becomes impossible. Attending the World Health Organisation (WHO) Executive Board meeting as a representative of the IAHPC gave me an opportunity to explore these issues. As part of the 154th Executive Board of WHO, I read a Constituency Statement on behalf of IAHPC as well as gave an Individual Statement under the Global Health and Peace Initiative.

Across all this is the need for pain control, such as for those with advancing cancer, for those with burns and crush injuries, for women delivering babies, for those at the end of their lives and who need to die with dignity. Underpinning this is holistic care for patients, families, and staff: this is core palliative care.  

Just stop for a minute and imagine being unwell in Gaza right now. There are almost NO strong painkillers like oral morphine available for ANYONE. So many factors lead to the lack of strong painkillers, but it is truly terrible and adds immeasurably to the suffering.

It was a privilege to attend the first WHO High Level Meeting on Non-Communicable Diseases in Humanitarian Emergencies in Copenhagen. So much work has gone into this, not least from the Eastern Mediterranean Office (EMRO) of WHO. It was heartening to see the member states attend (including Uganda) and many side events highlighting specific issues.

A recent report was shared which projected the risk of death and disease from NCDs in Gaza, but also infectious disease as the informal living arrangements are truly terrible. For example, right now in Gaza there is one toilet for 600 people and no clean water.

I took part in the Palliative Care side event and we had speakers either online or in the room from MSF, Vietnam, Haiti, Australia, Bangladesh, Sudan and Scotland (yours truly).

We are beginning to link more about NCD support with colleagues in Gaza, the Ministry of Health and in WHO. However, without a ceasefire the risk remains high for everyone and the ability to offer support is so limited. Oral morphine access is very complicated, but we hear so many stories of terrible pain and suffering which is heartbreaking and demoralising for staff, that we are keeping looking for ways to bridge this gap.

(Dr Mhoira Leng has since travelled with a Canadian team to explore these issues further and offer some clinical support, but most of all solidarity and presence. Another blog will be posted with further updates.) 

The last few weeks have been special for Muslims with Ramadan and for Christians with Easter. As we consider the time with its usual celebration, listen to what Suha, our wonderful oncology and palliative care pharmacist says.
“Like these days in previous years, we were racing to receive Ramadan with decorations, lanterns, and preparing Suhoor and Iftar menus throughout the month.
The streets of Khanyounis were full of people, decorations, crowds, and sounds of Ramadan welcoming songs.
Ramadan comes this year and we can't receive it in what befits it.”

The niece of Dr Amjad adds this, 
“We just wanted the most beautiful month of the year to come while we were in our homes preparing for it at this time. Five months … and our hopes, hearts, dreams, wishes, and finally our future are still destroyed. Thank you, world.”

Please continue to keep informed, be involved in any way you can, and pray. Here is a beautiful prayer from Professor Alison Phipps and a reply from her Gaza colleagues: 
     Bless the helplessness
     Bless the utter helplessness
     Bless the unutterable agony of utter helplessness 
     Bless the endlessness of the helplessness 
     Of a helplessness that still resists death daily
     Even as the helpless are dying for want of help

With the reply from Akram Sobhi Habeeb:
     Bless the help that never ends,
     Bless the endlessness of our friends
     Bless those who defy despair by planting hope,
     Bless the despair that ends with a strong rope,
     Bless those who pray for the end of the war,
     Bless those who keeps trying to open for us the door,
     Bless those who keep praying for our cute kids,
     Bless those who keep trying to make us well fed!

If you wish to donate to Cairdeas, then we are able to direct this to areas most in need.

Reflection on Advocacy with WHO for Non Communicable Disease in Emergencies

Snapshot of Dr Mhoira Leng speaking on behalf of IAHPC at the WHO 154th Executive Board.

Reflection on Advocacy with WHO for Non Communicable Disease in Emergencies

Sharing voices and the need to consider NCDs in humanitarian settings and emergencies.

Reflection on Advocacy with WHO for Non Communicable Disease in Emergencies

After spending February in India, Dr Mhoira Leng sits with colleagues from Uganda at the first WHO High Level Meeting on Non-Communicable Diseases in Humanitarian Emergencies in Copenhagen.

Reflection on Advocacy with WHO for Non Communicable Disease in Emergencies

Skies bright with hope in Copenhagen.

Reflection on Advocacy with WHO for Non Communicable Disease in Emergencies

A pleasure to see fellow colleagues in the humanitarian settings; Dr Rachel Coghlan and Dr James Smith.

Meet Cathy Namuto Magoola: Cairdeas Scholar

Hannah Ikong
22nd March 2024

Meet Cathy Namuto Magoola, the newest Cairdeas Scholar! Last month, Cathy began a one-year Advanced Diploma in Palliative Care programme with the Mulago School of Nursing and Midwifery in Kampala, Uganda. We are pleased to partner in Cathy’s nursing education and appreciate her role with PcERC at their unit in Kiruddu National Referral Hospital (KNRH). 

We first met Cathy nearly two years ago, in April 2022, as a nurse who was assigned by KNRH to work with the palliative care unit (PcERC, that is, Palliative care Education and Research Consortium). As a government nurse, Cathy did not have much prior experience in palliative care but was interested in the field and eager to learn. With the supervision of Sr. Nurse Florence Nalutaaya in PcERC, she soon was providing palliative care to the patients and families at the hospital. 

I have interacted with Cathy on many occasions, and from the beginning, she has always had a kind heart and listening ear. When we sat down for the interview (as the newest Cairdeas Scholar), midway Cathy quipped, “I’m talking too much!” Yet it is good to hear from Cathy and understand her approach to palliative care, with almost two years of on-the-job training with PcERC and new studies in her Advanced Diploma. 

“My mentors are nurse Florence and nurse Berna,” Cathy told me, “And they have not only been my mentors but my models in palliative care. I’ve learnt so much from them. Once, we had a patient who was really struggling on Level 5 in Kiruddu Hospital. His caregiver had abandoned him, and he had no one to help him get anything to eat. He was on oxygen, laying in bed, and too weak to go and do anything. 

She continued, “Nurse Berna found him one morning, trying to negotiate with another patient’s caregiver to help him eat, but that other carer was not taking the time to help! Berna stopped immediately and took time to feed the patient herself. Once he was strong enough to eat on his own, Berna worked with the hospital staff and with PcERC’s Comfort Fund to ensure the patient received food in a timely manner. He has already passed away, but he was very happy with Berna and appreciative of our palliative care team. I learned then that I have to create time for our patients.”

Her time now is stretched between working on the ward and attending classes for her Advanced Diploma in Palliative Care. “We attend class from Monday to Friday, and after the 5th of April, I will be going on a clinical placement for a month” Cathy told me. “Once we come back in May, there will be more classes and end of semester exams. I have been learning such amazing and new aspects of palliative care in class, from our course material to the experiences shared by my tutor and fellow students. These all help me be prepared for what is ahead of me.” 

What are the next steps for Cathy? In the immediate future, she is in an ethical issues course unit and is learning about will writing. “They are teaching us the foundation of palliative care, and we are each also preparing for a research project. I’ve identified my research topic to study on as ‘The Knowledge, Attitude, and Practices of Healthcare Workers in KNRH.’ I was very much interested in end of life care and researching that at my hospital, but they said that was done recently, so I am looking at the healthcare workers instead.”

“I have been very motivated to start this programme so I can be certified in prescribing [pain medication such as morphine]. Often I find one of our patients in pain and yet currently, in my level of nursing, I cannot prescribe anything for them. I have to go and find a doctor to write the prescription – and they are not always on the ward – while the patient waits in pain. With this Advanced Diploma in Palliative Care, I will be certified to prescribe, and be among some of the only nurse prescribers in Uganda.”

Cathy likewise hopes to continue her education in palliative care. “In the next 10 years, I would like to do my bachelor’s in nursing. One day I hope to go into management or tutorship, so I can teach fellow nurses.” When I asked her what she would like to teach, when she is a senior nurse, she quickly vouched for palliative care. “I want to stay in palliative care; the more that I work in this field, the more experience I get, the more I like it actually.”

“Many think that palliative care is for the dying,” Cathy told me. “But no, palliative care is aimed at improving the quality of life for the patient with life-limiting conditions. It needs to start from time of diagnosis; they shouldn’t wait to call in our palliative care unit when the patient is actively dying.” 

She’s communicated about palliative care recently to a surgeon who wasn’t yet ready to refer a patient with stomach cancer to palliative care. (The surgeon compiled, sending the patient and the family to the unit for support as they navigate cancer treatment.) She has been advocating for palliative care in KNRH and even in the other national referral hospital of Mulago. Cathy has well deserved her scholarship support from Cairdeas IPCT, which has supplemented her partial scholarship from the Palliative Care Association of Uganda (PCAU).

We are excited to see what is ahead for Cathy Namuto Magoola and with her work in palliative care, the Ugandan government hospitals will be a better place. 

Meet Cathy Namuto Magoola: Cairdeas Scholar

Meet Cathy Namuto Magoola; a government nurse stationed with the PcERC unit in Kiruddu National Referral Hospital.

Meet Cathy Namuto Magoola: Cairdeas Scholar

Sr Nurse Florence Nalutaaya (far left) from PcERC demonstrates the correct morphine dosage to Cathy Namuto Magoola (second from left), he patient and caregiver.

Meet Cathy Namuto Magoola: Cairdeas Scholar

It's Hat's On 4 Children's Palliative Care time with #ICPCN - this was last October with nurses Bernadette Basemera (left) and Cathy Namuto Magoola (right).

Meet Cathy Namuto Magoola: Cairdeas Scholar

Cathy Namuto Magoola (far left, in green) participates during a group activity during a Healthcare Worker's Palliative Care training by PcERC.

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