The injured girl and her caring cousin.

Three of the sisters were killed instantly – the fourth, eight-years-old, was blown through the front of the house and into the street below. At the hospital, she too was thought to be dead and was tagged to go to the morgue. Her cousin refused to believe that she was dead. He discovered that she had a pulse and insisted that she receive emergency treatment.

A family house destroyed by Israel.

Bob and I visited this family today. The little girl has asked repeatedly for her sisters and her cousin had requested consultation on helping her with her grief. She sustained brain damage in the blast and has short-term memory loss and tremors.

Her cousin described the remarkable progress she is

Grant O’Keefe teaching Trauma Life Support.

The family is surrounding this child with love – we were grateful to meet them. More than 2200 Gazans were killed in the summer “war.” Of the more than 11,000 people injured, nearly 3,500 were children. Thousands of homes in Gaza are filled with people providing care in the presence of profound grief.

Ned Rosch receiving thanks from GCMHP.

Earlier in the day, Maxine Fookson and I met with a group of women at the Aisha women’s empowerment clinic. Tomorrow, I’ll post their comments.

This evening, our group was hosted at a farewell gathering. Many of the people we have worked with through this week joined the staff of the Gaza Community Mental Health Programme in singing “Happy Birthday” to Bob Haynes!

The Gaza community has proven again to be resilient and courageous. Nearly every person we talk with asks for justice and the right to live free from occupation. We are grateful to have been so graciously received and hope to return to Gaza in April of next year.

Teaching ACLS.

The administration building at the Islamic University.

But they are also different. To get to class, the students hurry past the administration building, with its blown out front half. They crowd into the single elevator still functioning in the classroom tower, but with only men or only women in each packed carload. When the buzzer signals that the elevator is overweight, one or two students get off and wait, as part of an apparently routine protocol practiced several times per day. When a class finishes, many of the students climb to the 6th floor, as the elevator no longer comes to the 5th floor.

As the elevator doors close and the elevator zooms downward, I am startled by the pitch-blackness. The students continue their animated conversations, never pausing, as many simply flip on the flashlights in their smart phones for the rest of the ride. They make a point of not stopping conversation whenever the lights go out in a dark room (OR, restaurant, private home). I don’t know if this is because they have become inured to so many things not functioning as expected (“This is Gaza”, they say with a shrug of their shoulders). Or if, by not recognizing malfunction, there is no malfunction – nothing to become alarmed about.

The classroom windows are covered with cardboard material. Walking sometimes has some crunching feeling, with tiny specks of glass left behind from the shards already cleared away.

The students received our photocopied course materials 2 days prior to the course, and memorized all of the algorithms, protocols, medicines, and other lists – cold. When we pose questions, many eager hands are thrust into the air to be called upon.

On their way home, the students walk past piles of rubble where an apartment building once stood, but say nothing about it. Once home, they recharge their laptop if the electricity is on, so that they can study when the electricity is off (the majority of the time). Study space is scarce for some students at home. One related that 51 people stayed in her two-bedroom home during the war.

One of the nursing students show me a picture that I took last April, and indicated a classmate who, along with her two little children, was killed when a bomb landed on her home last August.

The Gaza medical students have the same keen intelligence and eagerness as their American counterparts. But they also have experienced something that no one should have to experience.

Gaza City across the sea.

A few of us started our day with a visit to the Gaza seaport. Gaza rests along the Mediterranean in what could be one of the most beautiful places on earth. The water was sparkling and the sunlight was warm as we walked along the breakwater. What is not seen: fishermen are allowed to fish only three nautical miles from the shore – in water that is shallow and polluted by the tens of thousands of tons of sewage deposited daily from Gaza into the Mediterranean.

The remains of destroyed buildings are used to increase sea barriers.

Our group then traveled by bus to have an overview of the current situation on the ground in Gaza. Hamada El Bayeri of UNOCHA joined us for two hours in the northern area. Hamada has guided our tours of Gaza on previous trips and we learn from his knowledge and wisdom.

Today, we returned to Shujayea to further understand the devastation of this summers’ attacks. Hamada talked about the need for Palestinians to be regarded as equal citizens of the world. Two weeks ago, Israel announced that Gaza would be allowed to export produce to the West Bank. Restrictions on fishing and the “off limits” areas along the border with Israel (35% of Gaza’s arable land) make production of salable items difficult. Hamada made the plea that we are hearing throughout Gaza: “We need to have equality and dignity.”

What’s left of a Save the Children school after the bombings.

One of the remaining dangers of the summer attacks is the high number of unexploded ordinance in the debris of destroyed homes. Last week, a four-year-old was playing in the remains of his home and was killed by the sudden explosion of one of the bombs. Approximately 15% of the 70,000 bombs that fell on Gaza during the summer are estimated to remain – so far – unexploded. Testing for the presence of toxic substances such as uranium 238 and other heavy metals from exploded bombs has not yet begun.

This afternoon, we journey to Khan Younis in the southern part of Gaza. Hosted by the family of a young man, Mohammed, now living in the United States, we toured through the area of Elzana, Khuzaa, Abasan and Bany Suhaila. In these border towns, Israel leveled many homes, mosques and businesses.

The crater from a bomb that killed one elderly man.

A twelve-year-old boy from our host family traveled with us to these towns and related that he has lived through three wars. This war, he said, was the worst – an assessment made by everyone we speak with. He was awakened one midnight by a bomb blast that struck a neighbor’s home. He and his family ran quickly to the neighbor’s house to discover nine people had been killed.

We enjoyed a dinner with Mohammed’s friends and family members then traveled again to meet with an Al Aqsa University professor. We wandered through his beautiful vegetable and fruit garden and were amazed by the production of food in dense, sandy soil. We were shown an enormous bomb crater and the early structure of a home being built to replace a garden home that was nearly completed when it was destroyed by a bomb.

To end the day, we were taken to a private basement museum and treated to classical Arabian oud music by a local group – music and culture surviving through war after war.

School children here in Gaza are always welcoming.

Photos of those who were recently killed by Israeli attacks are posted on cars and the rubble of buildings.

The group meets with Dr. Musa of UNRWA.

Each day we hear more stories. Here are a few:

During the 2014 war on Gaza, access to water was critical. It was summer, the weather was very hot and for safety, people were forced to remain inside their homes. The price of water was very high. Usually, there is grey water for toilet use and filtered water for consumption. During the war, only filtered water was delivered and the price was double. For many, water is delivered by truck and pumped to a tank on the roof of their building. Water truck drivers were very cautious about deliveries. Generally, two men deliver water – one to run the pump at the truck and one to place the hose on the roof. With armed drones visible above rooftops, only one man per truck ventured out. Families who wanted water were forced to send one of their family members to the roof to place the hose. A friend described the process of going to the roof with a hose, his wife and children terrified, watching and listening for drones, knowing that at any moment he could be targeted and killed.

Another friend told of medical supplies running low during the war. With the tunnels from Egypt closed, supplies now enter Gaza only through Israel. Following bombings when medicines, medical supplies ran low, we asked how did they get critically needed supplies. We were told that these items came through Israel but at a very high price. The cost of war in injury and the cost of war in treating the injury.

A young father related the days of having to stay in his house as being confusing for all the members of his family. Accustomed to having the father leave the house each day, the family was now clustered in their small living room – fearing the “knock” on the roof (Israel’s process of sending a warning to clear the house in advance of a bombing) and growing more restless and frustrated each day. “What am I to do?” he questioned. “I am the father, I am supposed to protect my children? Now they know and I know that I cannot protect them – there is no safety – there is no trust. When the attacks stopped, no one felt secure. To this day, no one feels secure. Everyone believes that the planes flying over our land could start again to kill Gaza.”

With a firm work ethic, a friend from previous visits told me that there is no work available in Gaza. During the war, jobs were available assisting journalists. This was extremely dangerous work – journalists were targeted and killed – but this friend risked working. Now there is no work. With the promise of reconstruction money that issued from the conference in Cairo, plans were made for jobs in rebuilding Gaza. But no money has been released. And so they wait.

Still another friend related the troubles faced by thousands who are now homeless. Many are sheltering with relatives, many in schools, and some in tents or temporary container buildings. Some have rented apartments, but the cost of renting a habitable apartment is prohibitive for most. With a median income of perhaps $200 – 300/month, a small apartment costs about $300 USD/month. Interestingly, prices for rent and major purchases such as computers or appliances are listed in U.S. dollars.

A medical professional related intricate plans for helping the people of Gaza to heal. Education of more mental health workers, plans for service in homes, and an attitude of promise that Gazans will continue to survive and eventually thrive keep this courageous man hopeful. There is no “giving up.”

The women’s group and their families. (Photo by Bob Haynes)

Advanced cardiac life support training. (Photo by Bob Haynes)

The war this summer was terrible – worse than any other in their memory. There seemed to be no end to it and everyone experienced the death or serious injury of someone close to them.

As refugees, these women receive assistance from UNRWA, but they report that UNRWA is now underfunded. The food assistance they used to receive has been cut in half and the financial assistance that had been 100 USD/month was cut to 80 USD/month and now is zero. Food is scarce and life is tenuous. The bombs this summer did not strike them, but they were close enough to rattle the windows of their homes and they continue to fear what might be yet to come.

As we talked, the room filled with children who were curious and friendly – the older children picking upthe younger and carrying them around the room. The front door remained open, allowing light to filter in from the street – the electricity is cut for at least 12 hours each day and my visit was in an electricity-free time.

ACLS instructors Bob Haynes and Bill Dienst with a hospital staff student.

This morning, several of us traveled to the Palestine Future Association – the Gaza Center for Cerebral Palsy – to meet with Dr. Al Kashif, Director. This inspiring man walks through rooms of children, gently touching heads or arms and receiving brilliant smiles of recognition and care.

The Center cares for all children in Gaza who have cerebral palsy – speech therapists, physical therapists, teachers of many special areas care tenderly for individual children and for integrated groups.

We were invited to dance with the children – several of them in wheel chairs. We had a lovely time and were inspired by monumental work being done in an environment affected – as is all of Gaza – by the siege. More equipment is needed. We brought gifts of Ipads to help the older children in developing computer skills.

We stopped at a kindergarten to donate some of the books and learning supplies that were given to us to bring to Gaza and we were

Some of the children at Al Amal Orphanage. (Photo by Bob Haynes)

This afternoon, we visited the Al Amal orphanage. The only orphanage in Gaza, Al Amal shelters 120 boys and girls from 5 years to late teens. This summer’s disaster left 1700 more children orphaned – adding to the 22,000 already needing care.

Most orphans are cared for in their families, but for some this is not possible and Al Amal serves as many as possible both in the facility and by visiting in homes. A much larger facility is needed! This facility is immaculately clean. Each child is responsible for maintaining her/his living space and food is prepared in a spotless kitchen.

Psychological support, physical education and cultural activities are provided on site and the children attend UNRWA schools. Still, the numbers of children needing care are overwhelming and the traumatized children who became orphans this summer require special attention. They are the unpublicized victims of war.

Maxine Fookson at the cochlear implant center.

Homes once stood where they are walking.

Growing hope in the midst of sorrow.

The Shujayea rehabilitation hospital was totally destroyed.

One of the mosques attacked and destroyed by Israel.

Destruction is everywhere.

In my language I know of no word or words sufficient to describe the scenes we saw today as we drove through the Sujayea area of Gaza. Around us, thousands of bombed-out wreckages of homes; before us, the shattered remains of the Al Wafa rehabilitation hospital. Imagining the families whose lives were forever changed in those brief moments of summer 2104, and then watching as family members now walked between the shards of their homes will remain with me forever.

One family, whose home was spared so that Israeli soldiers could claim it and live there for a time of occupation, has returned to repair the damage done by the soldiers to the inside of their home and to begin replanting their garden. Some families who have nowhere else to go occupy the shells of homes. These homes are statistically referred to as “partially destroyed” – even when the front of the home is missing and residence is claimed in rooms with only three sides.

In the rubble, fragments of toys, furniture, cookware, linens – the common stuff of life – provide startling reminders of a community. Why was this destruction deemed necessary? Who lives with the responsibility for this decision in their heart?

People who were living their lives, already struggling under siege, experienced the death of family members and now grieve loved ones, their homes and their community.

Earlier today, we had watched a community in action. We traveled with staff of the Palestinian Medical Relief Service to a remote area home where the homeowners had agreed to shelter a mobile clinic. A long line led from one of the rooms in the home – now designated as an exam and treatment area for the services provided by PMRS staff.

Physicians, nurses, physical therapists and other health care professionals make up the PMRS mobile clinic teams that go into areas where poverty makes it difficult for people to travel to central medical care. There are four such teams in Gaza and they see patients in these home (mobile) clinics each day.

We visited a home where the PMRS dressing team was caring for a bedridden woman. This woman’s legs were broken and burned by a war blast in August – a blast that killed her eight-year-old daughter as they walked through a market. For a time, the woman had been cared for in a Jerusalem hospital. When she was returned to her home, the PMRS team assumed responsibility for her daily care – she is healing well while she also grieves.

PMRS served Gaza in an expanded group of ten mobile clinics during the 51 days of attacks – braving travel that proved lethal for some medical workers in Gaza.

Everywhere we go in Gaza, as in previous visits, we meet courageous people who are intent on making life better for Gaza. This morning, we visited the Al Amal Cochlear Implant Center. Al Amal functions in two buildings. One is a rehabilitation center for helping children utilize their implants. Here, the classes are small and speech therapists work with groups of children to help them fully utilize the implants. The second facility is a school where students with implants are successfully integrated into classrooms with non-hearing impaired students.

Al Amal claims the highest honors for their work. Many of the children they serve are hearing impaired due to war injuries. Cochlear implant equipment is expensive and the waiting list for service at the Center is long.

Throughout Gaza, many healthcare workers and

A member of a Red Crescent team, hard at work.

At dinner tonight, we met with Dr. Muhammad Al Kashif, Director General of International Cooperation of the Ministry of Health. As he reviewed the challenges to life and medical care here, we expressed our gratitude to him for welcoming us to Gaza. His generous work with staff from the Gaza Community Mental Health Programme has made it possible for our teams to work in Gaza.

With the borders closed, Gaza faces a fuel crisis. (Photo by Bob Haynes)

Some families in Gaza are forced to find shelter amid metal scraps. (Photo by Bob Haynes)

People living in what’s left of their bombed home. (Photo by Bob Haynes)

A UNRWA school in Gaza, now temporary housing. (Photo by Bob Haynes)

Ned Rosch and I delivered suitcases full of medicines to GCMHP. The medicines, funded by donations from Iowa and Washington state, were joyfully received. Many of these medicines were out of stock in the GCMHP pharmacy and are needed for the care of traumatized, war-affected Gazans.

Ned and I were then given a tour of children’s facilities in Deir Al Balah, an impoverished area in central Gaza. The inspiring work being done by Reem Abu Jaber and her colleagues to help the children of this area is many faceted. A Waqf (Google – this was Reem’s gift) kindergarten founded four years ago is functioning beautifully. Last April, Reem (who was the original director of Qattan Center for the Child in Gaza City), received permission to open an Arts and Cultural Center for Children.

NAWA receives educational support from Waldorf Steiner personnel of Germany and is opening its doors to an increasing number of children. This is a resident area, not a refugee area, and the UN does not serve resident children. On the logo for Nawa, a quote from Edward Said reads, “The Power of Culture rather than the Culture of Power.” NAWA presently functions in a very small space but will soon move to a larger home – thus, increasing its capacity to serve neighborhood children.

Reem’s new project – planned for opening in April 2015 – is the renovation of a 1700-year-old Christian monastery. This centrally located building will be the first library for the children of Deir Al Balah in more than 40 years. Children and friends in the US sent with us books and financial support for Reem’s projects.

This afternoon, members of our group toured Beit Hanoun children’s specialty hospital, which was damaged by Israeli weapons in the war this past summer. The neighborhoods around the hospital were badly damaged in a process known as “mowing the lawn.” Families continue to live in makeshift shelters. Many of these shelters were constructed of cardboard-like material that was damaged by recent heavy rains. Some of the homeless are camping in local UN schools (UNRWA) while students continue to double shift for classes.

The physical and psychological toll of war lives in every resident of Gaza. No one was untouched by the summer’s tragedy. That people are able to carry on with love for one another is humbling.

When night falls, Israeli planes regularly fly above Gaza – emphasizing the precarious nature of the present ceasefire. Nearly everyone we talk with mentions the expectation that war will come again.

This evening, a nurse from Al Aqsa Hospital visited us in the Marna House garden. This gentle and generous young man told stories of members of his own family who died or were desperately injured this summer. His grandmother’s chest was lacerated by a piece of shrapnel and this nurse changed her dressings every day for three weeks, carefully observing for and protecting against the possibility of infection. One of his cousins was blown from her home and is brain damaged. Realizing that his relatives were homeless, he gave up his apartment to 10 family members and now is happily “rebinding connections” with his parents.

During the war, I was in touch with this nurse and know that he worked endless shifts in his hospital and slept rarely. He is truly an inspiring soul.

Ministry of Finance, before being targeted by Israel. (Photo by Grant O’Keefe, April, 2014)

Ministry of Finance after being targeted by Israel. (Photo by Bob Haynes, November 2014)

Our tuk tuk piled high with luggage. (Photo by Bob Haynes, November 2014)

Today, we journeyed once more to Gaza. Nine medical professionals entered through the Erez Checkpoint – hosted again by the Gaza Community Mental Health Programme (GCMHP). We miss those who have traveled with us in the past and welcome new members of our team. Our thoughts are with Dr. Rich Grady and his wife, Dr. Laura Hart as Rich recovers from major surgery. Many in Gaza will miss them during this visit.

Entry through the Erez Checkpoint is complex – requiring a time-intensive (weeks) application process and patience from all sides to gain entry permission. The physical entry is arduous, comprised of numerous entry and passport checks and a long walk (or ride on a tuk tuk – see photo) through a metal cage – overseen by the armed Israeli guard towers along the separation wall.

We were greeted on the Gaza side by staff of GCMHP and after clearing the Palestinian checkpoints; we began the stunning drive through Beit Hanoun – site of numerous summer bombings. We heard from our hosts stories of loved ones who were killed or tragically injured during the 51 days of warring in July/August. Driving through Gaza, destroyed buildings appear in shocking frequency. Sites such as the Ministry of Finance were targeted – see before and after photos.

A quick check-in at the Marna House was followed by a loving greeting at the GCMHP Center. Friends and colleagues welcomed us and told of their summer of sorrow. Gaza Community Mental Health staff work constantly to help the traumatized people of this seacoast enclave. Densely populated (1. 7 – 1.8 million people in 340 sq. Km), the people of Gaza live with the continuous knowledge that air, land and sea attacks can begin again at any moment. The echoes of death, injury, destruction of homes, businesses and schools haunt them.

Work begins: the three surgeons, one cardiologist and one emergency/family practice physician met with colleagues to plan the days ahead. The nurse practitioner and stress management provider will be busy. The psychologist in this group has served before in Gaza and will work with the GCMHP staff. My work will be varied and I look forward to time with women empowerment groups, the cochlear implant staff, orphans, schools, a new arts/culture/library center director and other interactions that will involve many members of our team.

Generous donations from people in Iowa and Oregon and Washington have provided the critically needed medicines and medical supplies, books and toys that filled our luggage. We look forward to giving these gifts from so many who care about Gaza.

(Washington Physicians for Social Responsibility has been sponsoring delegations to Gaza since 1993. In 2009, the group began offering medical service work to the people of Gaza.)

Leaving Gaza is always difficult: difficult to leave our friends knowing that their imprisonment continues, difficult to contemplate how much strength it takes for them to maintain their courage and hope, and then the minor difficult of the transit through the checkpoints. Two friends came early to Marna House Hotel to say “Good-bye.”

Moving across the small segment of land through the Gaza and Israeli checkpoints can take many minutes to many hours. On the Israeli side, every item in our luggage was checked and scrambled. One day later, we are still finding objects in our suitcases that belong to one another! Yet, finally, yesterday, after about 2 ½ hours we emerged and were greeted by the driver sent to us from our friend Daniel of Bethlehem. The day was spectacularly beautiful and we drove the curving road up to Bethlehem – where we will spend nights until we return to the US.

In the afternoon, on our way to dinner with Mustafa Barghouti and his staff from the Palestinian Medical Relief Society in Ramallah, we stopped in Jerusalem to observe the thousands of pilgrims walking from the Mt. of Olives to the Old City, celebrating Palm Sunday.

Settlements dot so many hills in the West Bank – erected on occupied land against international law. Leaving Area C, moving into Area A, the Israeli Qalandia checkpoint was slow, but we arrived in good time in Ramallah. We had a wonderful dinner – planning the next two days of service in Ramallah, Tulkarem and Hebron. We are grateful to Wi’am in Bethlehem for helping us to organize our time in the West Bank and to the Palestinian Medical Relief Society for providing opportunities for us to serve in West Bank communities.

Saying “Farewell” to friends – friends we have returned to and friends we have just met – is unsettling. We are so very thankful for this time in Gaza and wish the imprisonment of nearly two million wonderful people would end.

All that remains of a bombed building. Photo by Bob Haynes.

We discussed the rate of

Children greet Bob Haynes. Photo by Bob Haynes.

In a situation where computer equipment is difficult to obtain and maintain, it is hard to quantify the prevalence of any disease or condition. The single exception to this: The rate of vaccination for communicable childhood diseases is 100% – children are not allowed to attend school without a current

Gerri Haynes thanks Bob Haynes for teaching.

This afternoon, Bob and I returned to a northern Gaza area where a dear friend lives. She and her friends particularly like the homemade chocolates that our Kirkland neighbor, Susan, makes and sends with us each time we visit Gaza. I was so happy to be able to give my friend and her family some of this delicious treat again!

She is a nurse, will have a Caesarian birth later this month – her third child in four years. We hope this third Caesarian will go beautifully.

A local mosque at sunset. Photo by Bob Haynes.

Traffic in Gaza is amazing – hundreds of thousands of people moving rapidly through the streets (cars, trucks, donkey carts, pedestrians) and rarely a traffic light, street sign or patrol person. Without the guidance of GCMHP, we would have been lost!!

Tomorrow, we will pass again through the Erez checkpoint and go to Bethlehem. We’re planning to work with the Palestinian Medical Relief Service for several days in the West Bank before we fly home next week. We are grateful for this time in Gaza… When will we be here again?