Doctor's heartbreaking decisions choosing which babies live or die

Dr Aaliyah described the toll that the war in Gaza is having on the innocents in her care (Picture: ActionAid Palestine)

A Palestinian doctor in southern Gaza has told of her heartbreak at effectively having to choose which babies live or die in an overcrowded maternity hospital.

Dr Aaliyah spoke of the ‘disaster’ of having to fit up to four newborns in incubators meant for one due to a critical lack of facilities at Al Hilal Emirates Hospital in Rafah City.

The overburdened wards she works on would usually have 10 or 11 babies at a time, with each in an individual incubator, but they currently have 70 sharing the clear boxes.

A shortage of life-preserving artificial respirators is also taking a toll, with doctors having to prioritise which newborns to assist with breathing.

However the Rafah resident has been given hope in the form of an orphaned baby girl named Malak who she has taken in.

The displaced war child was among a large influx of newborns from the north and Al-Shifa Hospital in the Gaza Strip, which has been left in ruins after the Israeli military’s siege and consequent occupation.

In a video recorded at the hospital, Dr Aaliyah said: ‘Look how great the suffering is that we experience while dealing with such cases.

Dr Aaliyah and her team have been left exhausted trying to cope with the huge influx of patients (Picture: ActionAid Palestine)

‘Each incubator is supposed to support one child. In the name of God.

‘But due to the war and the accumulation of cases here mostly all of the cases from the north, Khan Younis and central Gaza are treated in Rafah.

‘We have to have three or four babies in each incubator.

‘This is what makes the treatment here less efficient than is necessary.’

Stress and anxiety experienced by mothers amid catastrophic humanitarian conditions affect the infants, who are born tired and with breathing difficulties, Dr Aaliyah said.

Even when babies make it to the hospital, which specialises in maternity and infant healthcare, they often pick up infections from each other due to overcrowding.

The 32-year-old medic, whose name has been changed to protect her identity, attended to one incubator with four newborns in, carefully feeding one from a bottle.

‘In the beginning, we used to accommodate 10 or 11 cases, and now we accommodate 70 cases,’ she said.

‘Seventy cases. We had to open another department and as much as possible we provide incubators, but we cannot provide the needed number. So an incubator could have three or four children in it.

‘The total number of babies being treated in the nurseries ward has reached 70 cases, and this is a disaster.’

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Sepsis is a particular risk at the hospital, which means that even babies which manage to survive take longer to discharge because they are weak.

Many of the innocents arrive from tents after being displaced by the war in the Gaza Strip, scene of intense Israeli military action in response to October 6 Hamas terror attacks.

The mothers are exposed to cold weather and some are unable to breastfeed due to a lack of food, drink and nutrition, Dr Aaliyah told filmmakers for ActionAid Palestine.

Babies have had to share incubators due to overcrowding at Al Hilal Emirates Hospital in Rafah (Picture: ActionAid Palestine)

‘They arrive here in a very bad situation and many die here,’ she said.

‘With every shift, two or three infants die, due to infection and because of the health situation in Gaza.

‘Another point is that we do not have enough equipment for these children. For example, artificial respirators are not fully available here.

‘There are many cases that require artificial respiration, but there are not enough devices for them, so we are forced to choose between these children, to see who among them has a better health condition and we put them on the artificial respiration, and not the others.

‘Unfortunately, there is nothing we can do for them.’

Hospital medics have been forced to make agonising choices of which infants to prioritise for survival (Picture: ActionAid Palestine)

Amid the pain and uncertainty, Dr Aaliyah has found hope in the tiny form of a baby who she has taken in and named Malak.

The newborn, whose identity and family background is unknown, arrived from Al-Shifa as Israeli military operations in the north led to a huge influx of people into Rafah.

‘This little girl had a huge impact on me from the first day I saw her,’ Dr Aaliyah said.

‘Her health condition was fairly good. From the first week she got better, after that there was no one to take her because there is no one who could recognize her.

‘Unfortunately no one came to ask about her.

‘We had to keep her in the department for two months, and as you know, if she is in the department and she is in a good health condition with children who have health problems, this makes her vulnerable to any disease.

‘Many children suffer from sepsis as a result of their presence in the nursery section only.

‘I was worried for this girl, because glory be to God, how God planted her love in me. I felt that she was from me, I felt that she means a lot to me, and thank God I was able to get her out of the department, and now she is with me at home and has been for a month and a half.’

The health worker said that Malak is a survivor of what she described as the ‘Al-Sabra neighbourhood massacre’, referring to an area in Gaza City which has been heavily targeted by the Israeli military.

Her team is trying to reach out to the unknown’s family and she is worried about the child’s future and her identity when she grows up.

Short-staffed and faced with the possibility of an Israeli ground assault on the south that might mean having to leave the hospital, Dr Aaliyah says she and her colleagues are working to the point of collapse.

‘Malak, honestly, is the sweetest thing that happened to me during the war, as if she was something God sent to alleviate the conditions we are suffering from,’ she said.

A Palestinian medic cares for babies born pre-term at the Al Hilal Emirates Hospital in Rafah (Picture: AFP via Getty Images

‘Yes, she came under difficult circumstances. It is difficult for me and for her. But thank God, God is always standing with us. And all things become easy with regards to Malak, and there are no difficulties that I face.

‘So I feel like it’s a nice thing that happened to me, and I don’t feel like it’s a burden at all. I do not feel the weight of responsibility towards her, it just feels like the responsibility of a mother towards her daughter, in very normal circumstances.’

The doctor had intended to keep working at the hospital if the Israeli Defence Forces (IDF) extended their ground campaign, but now feels a responsibility to leave in order to keep Malak safe.

‘In the beginning, before Malak, I had decided that in the event of displacement, I would stay in the hospital and keep doing my work, but since Malak has been with me, my situation has changed,’ she said.

‘I became afraid for her, and afraid that displacement would happen.

‘Where can I take her to? And will I be able to provide her with the necessary facilities she needs or not?

‘The thing that scares me the most is this topic.’

Palestinian babies lie in one incubator due to the limited capacity at the Al Hilal Emirates Hospital (Picture: Reuters)

With the lives of her team and patients weighing in the balance ahead of the possible incursion, Dr Aaliyah had a message for the wider world.

‘My message to the world is that, frankly, we hope that the war will stop because we are completely exhausted, she said.

‘All our energy was drained by the war.

‘We hope that the world will stop this war as soon as possible.’

The UN’s human rights chief said this week that he was ‘horrified’ by the destruction of Gaza’s Nasser and Al-Shifa hospitals.

Volker Türk also called for an independent investigation into reports of mass graves at the facilities after IDF raids.

The Israeli military rejected claims that it had buried bodies at Nasser in Khan Younis as ‘baseless’ and shared a post on X which claimed the grave was dug by Gazans.

Men ride a motorcycle past a destroyed building in Khan Younis after Israel pulled its ground forces out of the city (Picture: AFP via Getty Images)

Riham Jafari, advocacy and communications coordinator at ActionAid Palestine said: ‘The situation in Gaza is so dire that doctors are having to make impossible decisions about which patients to prioritise for care.

‘It is heartbreaking to hear of newborn babies struggling to survive because there simply aren’t enough incubators to go around.

‘Without sufficient fuel, incubators cannot operate, yet the delivery of fuel has frequently been denied by the Israeli authorities.

‘More than six months of bombardment has left Gaza’s health system on the brink of collapse.

‘Only 11 hospitals in Gaza are currently partially functioning, and only three of these are able to provide maternity care.

‘The severe shortage of medicines and equipment is leaving surgeons with no option but to carry out amputations and caesareans without anaesthetics.’

A woman cries on rubble after Israeli forces’ withdrawal from Khan Younis in Gaza (Picture: Jehad Alshrafi/Anadolu via Getty Images)

More than half of the Palestinian territory’s 2.3 million population are thought to have fled to Rafah during the seven months of war.

The conflict has cost more than 34,000 Palestinian lives to date, according to the Ministry of Health in Gaza.

Mr Jafari spoke as the Israeli military signalled that it is preparing for an offensive on Rafah, saying that it plans to evacuate civilians from the city

‘Medical staff are overwhelmed and exhausted, starving and traumatised,’ he said. ‘Gaza’s hospitals urgently need more medicines, fuel, food and water to keep them running, but aid is still not entering Gaza on anything like the enormous scale required.

‘Aid must be significantly ramped up, immediately, to save Gaza’s health system from total collapse and prevent more people dying from malnutrition and disease.

‘Ultimately however, the only way to stop the appalling death toll climbing any higher is for there to be a permanent ceasefire in Gaza, now.’

The IDF reposted content on X this week appearing to show hundreds of aid trucks moving into and out of Gaza.

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