A Doctor in Gaza: “The hardest part is deciding who gets anesthesia”

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When we planned the Central American Journalism Forum (ForoCAP), we knew that in 2025, a gathering of journalists could not be held without talking about Gaza. We thought of our colleagues, more than 200 Palestinian journalists murdered since the war began. And we asked ourselves a question: Who is telling us about Gaza? Palestinian journalists are telling us, those who continue to work without electricity, without equipment, burying their own children, risking their lives.

Recently, in Vienna, I met Wael Al-Dahdouh, the head of Al Jazeera's Gaza Bureau, who lost his wife, three of his children, and his cameraman in various Israeli attacks. During an assault on the vehicle they were traveling in, Al-Dahdouh miraculously survived. In Vienna, he told me, “Our Western colleagues abandoned us.” Israel, he reminded me, presents the journalists it kills as terrorists or Hamas members. And a good part of international journalism repeats that version without verifying it, or leaves that suspicion hanging over them, despite the fact that Israel never presents evidence for its allegations to murder journalists or humanitarian workers.

That made me ashamed because I think he’s right. World journalism has abandoned our Palestinian colleagues. That’s why we decided that we didn’t want expert journalists to talk about Gaza, but rather witnesses. During ForoCAP, we screened “Inside Gaza,” a documentary about AFP journalists in the Strip, and we also managed to bring a doctor to hear from those who tell us about Gaza from another front: doctors and humanitarian workers, almost the only foreigners who can enter and leave.

My guest is Homero de León, a Mexican doctor who has worked with Doctors Without Borders since 2018. He has worked in 15 countries in an array of contexts, but there’s one place he has returned to three times since 2024: Gaza. I contacted him a little over a month ago when he was still in a hospital in Gaza. I asked him if he didn’t prefer to go home, rest, see his family, and he replied, “It’s very important for me to be there. It’s very important to bear witness to what I’ve seen.” The following conversation was recorded live on November 8 in Antigua Guatemala during the Central American Journalism Forum, a few days after Homero finished his third shift in Gaza.

Why do you think it’s important to be here despite the exhaustion, despite everything you’ve been through?

Thank you very much for the invitation, for this space to talk about something that needs to be talked about, that cannot be forgotten. Despite the exhaustion, I believe I have a commitment as a humanitarian doctor, but also as a human being, to denounce this suffering that’s being experienced, and it’s a commitment that goes beyond healing wounds, saving lives, and providing medical assistance. I believe this is about protecting human dignity and ensuring that this continues to be talked about so that it doesn’t remain silent.

For us, part of having you here is that we have been hearing about it for two years, and every day we see a lot of things on social media, but we don’t know what it’s like to be there. You’ve been working under intense bombardments, you’ve been working in emergencies. Tell us a little bit first about which areas you’ve been in and what exactly you’ve been doing.

Yes, I’ve been inside the Strip three times since the conflict began. The first time I was in Khan Younis, which is a part of the south. The second time I was in Gaza City itself, and the third time I returned to Khan Younis. We have different activities in both locations. In Khan Younis, there are more activities that I had to manage or be directly involved in: supporting Nasser Hospital, which is a hospital of reference, the largest one currently in the south, and directing the maternal and child building, a large building with more than 110 beds, pediatric intensive care, neonatal intensive care, and an operating room. And we also have two comprehensive health clinics that offer all primary care services and an emergency area. And in Gaza City, we opened a project there in coordination with the Ministry of Health for a maternal-gynecological-obstetric hospital and the neonatal intensive care unit.

What was your daily life like there?

It’s a very tricky and difficult question because there is no daily life, I think it’s hour by hour. The context within Gaza changes constantly, no matter how much you plan your two months, your month, your week, or your day, from one minute to the next, from one hour to the next, you have to change everything. So there isn’t really a routine. Well, what I can say is routine in Gaza is making difficult decisions.

As you saw in the documentary —if not, it’s well known— there is a scarcity of resources, medical supplies, food. In this case, particularly the scarcity of medical supplies: antibiotics, anesthetics or analgesics, pain medications. And one of the hardest decisions that are made daily is, so that you don’t run out of pain medication, who are you going to administer it to and who are you not? Who are you going to perform minor surgery on or a deep wound cleaning under analgesia, under anesthesia, and who are you not? It’s a difficult decision to make and it hurts your soul to tell the person that it’s going to hurt more. Among other difficult decisions.

But that’s a decision with many implications. How do you decide who gets it and who doesn’t?

There are certain types of protocols, but besides, it’s a direct question. You tell the patient directly, “You know what? There are very few supplies, there’s a shortage of this.” And most of them agree. It’s a very close-knit community and they accept it. They say, “Okay, do it, I can endure that pain so my companion doesn’t have pain.”

We’ve all seen images of injured children. You’ve been treating many children. Of all the injured, when one thinks of emergency medical care in Gaza, one thinks of the children who are bleeding, who are arriving by ambulance, of the women. Of the men too, of course. But from what you’re saying, obviously for a medical service there are many other things to attend to. There are no resources, no medicines. In a country under normal conditions, there are diseases to attend to, chronic diseases. I suppose this is aggravated when there’s no water, when everyone is overcrowded. Tell us a little about that, please.

Yes, of course, and it’s very important. Some people have asked me, “But with the ceasefire, there won’t be any more injured people. What will the medical team in Gaza do?” And we’ve thought about that. Obviously, these people directly injured by war, either by bullets or as victims of an explosion, are the most striking, and appear most in the media. But as Carlos mentions, there’s a primary health care service that continues, and it’s practically collapsed. There’s a large number of patients with chronic-degenerative diseases, or children, who must follow their vaccination schedule. Pregnant women who must have their prenatal and postnatal follow-up. All of this is forgotten and we only look at what’s most striking.

There’s no medicine in certain cases when the border is completely blocked. There’s no way to get medicine in. So, these patients will have complications, they’ll get worse. If we add to this a shortage of food, then without nutrition, wounds will not heal, fractures will continue. It will reach a point where patients don’t heal and infections proliferate. And we’ve seen this in the number of amputations there are. The number of adults and children with complicated amputations is alarming, as well as the physical and mental consequences that this entails.

[rel1]

Put us in your hospital. Explain it to us beyond the report, from your experience.

It’s not easy at all. But I want to focus a little more on mental health, which is something we tend to leave out of our attention. In our health centers, we have mental health activities for children. I went to one and I saw the children dancing and playing. It filled me with tenderness and joy. They’re being children, even though they’re normalizing a life of precariousness and violence. And if a child is five years old, half of their life has already been constant violence, suffering, and death. And I was happy about this situation. I saw them dancing, doing a very particular choreography. I was happy.

The translator approached me and said, “Homero, do you want me to translate the lyrics?” And I thought, “Oh, it must be about a spider or something that they’re playing with.” And no, the lyrics of the song were, “What to do if a bomb falls near me? How do I take shelter? Where do I go? What do I do if my mom doesn’t move anymore? What do I do if my dad is under rubble?” It was like being doused with cold water all of the sudden. And it makes you realize where you are. I’m here for that, and that’s part of what motivates you to continue, to give everything you can for them.

In this situation that we’ve just seen in images, that we have been seeing for two years, there are almost 100,000 confirmed deaths, a third of them children. But I understand that the death toll is so large that sometimes other figures dissipate. There’s an absurd number of children who’ve been orphaned, for example. You must have had to treat them, but their family didn’t survive. What happens to these children, now that the population is sleeping in tents — the few who have these resources for tents? What happens to a child who’s orphaned in Gaza?

Yes, they’re heartbreaking images, to see a seven-year-old child covered in blood, carrying his three-year-old brother, arriving at the emergency room. Where are the parents? Obviously, you don’t ask because you know the parents won’t arrive. For these children, fortunately, there are certain organizations within Gaza. We all support each other, and they have certain temporary orphanages where they are taken in, and after that, honestly, I lose track of them. But imagine the life they lead, the emotional impact, the burden that’s there. I don’t know. I have no words for that.

[Referencing the picture above, projected onto a big screen:] I asked Homero to send us some photos he took with his phone, so he could explain a little about life in Gaza.

Those who saw the documentary realized the precarious situation they’re living in. They were forced to leave their homes. Not just their houses, he mentioned home as their community, their neighborhood, their frequent cafés, the stores they went to. All of that was razed. With this massive displacement, as we see, they had to adapt. Most of these people live in overcrowded, temporary shelters. They’re not even tents. We see blankets used as walls, we see tarps, we see mats, or some don’t even have that. They’re just on the street. And all of this is a serious health problem. There are no latrines, no access to drinking water, no access to nearby health services. All of this leads to respiratory infections because of overcrowding, lots of diarrhea… Skin infections are very common in children, and without top-of-the-line medications or antibiotics, you try with second and third-rate ones, with whatever you have available.

It’s certainly true that sometimes they’re not very effective because they’re not first-rate, and they lead to complications. The hospital I mentioned, Nasser, has 110 beds. In the three rotations I was there, there was never a moment when we had less than 180 patients. Patients were —depending on their size, if they were very small— two or three per bed, or in the hallways. If the family could bring a mattress, we would put it there. If not, we would give them a sheet. And the local doctors and nurses treat them right there. But yes, these are strong images. This was from the first rotation. Unfortunately, in the third one I went to, everything in the back no longer exists. It’s just rubble.

In the documentary, we saw a more or less similar camp, and I saw people digging trenches. I suppose it’s for when it rains, when the health situation must worsen.

It’s for rain, but more than anything, they’re latrines. Since there’s no access to bathrooms or toilets, people create trenches. It’s a communal bathroom. They just cover it however they can.

That’s on the way to the hospital. It’s a street I traveled every day. And this is just one. Honestly, I didn’t take many photos out of respect, because the person driving is a local colleague. At one point, he told me, “Take photos, talk about us, show what’s happening here.” But even so, it feels like a spectacle. That’s exactly how it is, but he told me, “Take it.” Because he saw me with the phone. We can see if people are not in those shelters, they are living among rubble.

This is one of the hospitals where you worked.

Yes, the pediatric area, to be exact. That’s just one example. We took that with the consent of the patient and her mother, and it was just before it started to fill up. The ones after that, I didn’t want to take them because I didn’t have informed consent for everyone to sign. There was no space to put children in the hallway. And that’s a constant thing, and not just in our hospital. For our hospital, being a facility of reference, we had a lot, but all the others were full anyway. It’s just an image from before it filled up. As we can see, those mattresses were brought by the patients. We no longer had the capacity to provide them with that. And all of this exacerbates everything: the prevention or control of infections that should normally be carried out in a hospital. The distances between patients are not met.

In the neonatal intensive care unit, we saw an increase in the birth of premature babies, many of them weighing less than one kilo. We had to have two or three of them per incubator. And even intubated with the ventilator, there had to be two or three, with all the risks that entails. But they’re risky decisions you have to make. You have to attend to the child, you have to put the baby there, otherwise where will they be attended to? In Nasser, we had 22 incubators, and we never had fewer than 22 patients. Just the week before last, before coming here, we had 36. And that’s constant, constant, constant.

This is very similar to the documentary: It’s to show you how people live in such a crowded way. They’re not properly in houses, they’re not blocks, they’re not creating streets. They just settle wherever they find a place. Precisely here is what was called —as you saw in the documentary— the humanitarian area or the humanitarian zone. Honestly, there wasn’t much humanitarian about it, because we did have several mishaps or security incidents right there. It’s right on the edge of the beach, and for that very reason people felt safe. They thought that the farthest they could be was the safest. Unfortunately, we all realized that, thanks to this, there is no safe place in Gaza.

This also shows the level of destruction and devastation that exists in Gaza. I took it quickly, as we were in the van, because the child caught my attention a lot. The child didn’t move. We stood for a while later in the building that is a little farther down, and I saw the child sitting there. The child didn’t move for 15 minutes from the same position. What is he thinking? What is he feeling? All of these are everyday reflections. Where does he live? If he lives there, is he alone? In the background, you can see a destroyed city, but the impact it’s having on the child population…

[newsletter]

Before this conversation, you told me that you had let your Palestinian colleagues, the staff in the hospitals, know that you were coming, and you asked them what they thought you should say. They told you, “Speak for us.” What do you have to say on their behalf?

They feel —not all of them, obviously— but they feel like just another statistic. They’re a number. We saw 67,000 dead or more, on top of the hundreds or thousands missing among the rubble. And they told me, “I’m a statistic.” In fact, I’m going to allow myself to read it, to say exactly what they told me. A very strong bond is created between colleagues: seeing that someone is there for them as a community, and for me, taking into account that our Palestinian colleagues at Doctors Without Borders are part of the population we care for. Being with them creates a very important bond, a lot of trust is created, and they are very open to telling you things.

One colleague told me: “We’re no longer people, that has been taken from us. Now we’re just numbers, just figures. It’s impossible for me to have deep conversations with anyone else. That no longer exists. Now, I’m two people: one who is fake, social, and smiling at work; and the real one who, from the moment I get home, can’t stop crying until the next day. I’m a person who only cries. Why do I say person? I’m an entity that only cries, because I stopped being a person a long time ago.”

I was speechless. What can you say to this person? I’m here to support you, and all. Fortunately for me, they don’t expect you to answer, they just want to open up to you. They want to tell you how they feel.

Homero, I want to go back to your Palestinian colleagues, to those who stay there when you leave. But first, tell us about when you enter, because you’re going in and out, and you leave for two months. You said that every time you entered, you carried three suitcases. What did you carry?

Yes. It’s a whole process to enter Gaza. You must have authorization, obviously, from the Israeli authorities to do so. Only one suitcase is allowed for international personnel. In that suitcase are personal items, including three kilos of food for personal consumption. To begin with, I wondered, why only three kilos? Why are they limiting me? But it’s part of the game, it’s part of knowing from the beginning who’s in power, who’s in charge. And it’s a game that unfortunately you have to play, otherwise you don’t get in and you don’t do your job. Entering and leaving Gaza is difficult. We start from Jordan in a convoy, we get on a bus, us along with other agencies and organizations. That bus, when leaving Jordan and entering Israeli territory, is escorted by military police. So, the entire journey from Jordan to the lower part of where the Gaza Strip is, as we saw in Rafah, almost next to Egypt, is the entrance. That entire journey is guarded by military police and you cannot get off the bus.

Once you arrive at the border, it’s impressive. You see a five-meter wall heavily guarded by soldiers. You go through a meticulous inspection of all your belongings. In this inspection, as part of the game, they decide what enters and what doesn’t. We took risks and tried to bring in whatever we could, even if it was little medical supplies, or toys for the children, for our mental health activities. Sometimes they would take them, sometimes they would get in. After that, after the inspection, you get into armored vehicles with your protection —bulletproof vest, tactical helmet— and you have to go directly to the meeting point without stopping. The meeting point is in the center of the strip.

From the moment you get into the armored car until then, normally if all goes well, it takes two hours. But I tell you, it never goes well. And we’ve done six, seven, eight hours. Because as you’re moving forward, they receive calls and you have to stop the convoy due to military activities in the area or simply because of the poor quality of the roads, which are no longer roads. They’re either full of rubble or simply destroyed, either by bombings or by tanks passing through, and it’s impossible for us to pass. They have to look for the route. At the meeting point, everyone goes to the agencies or organizations they belong to.

When you leave, there are more contrasts and it’s more impactful. Being inside the Strip and being under constant bombardment; having surveillance drones 24 hours a day, all week, very low, like background noise; the jets flying very, very low; the gunshots and explosions as background noise, adding to the bombs; the missiles that fall nearby; the rumble, the roar, the vibration of the structure where you are. And I tell you, they fall very close. The closest ones fell less than 100 meters from where I was.

Upon leaving, it’s the same procedure. You pass through every time you cross what was a city. It’s no longer a city, it’s a sea of rubble. It’s something that cannot be described and they mentioned it in the documentary. There is no Hollywood movie or anything that can represent the level of destruction and devastation that exists. On this road, unfortunately, I’ve seen corpses, I’ve seen sacks of food where the few trucks that managed to enter would come in and people would rush. But upon reaching that wall again, you cross it after another more thorough inspection, because nothing can leave Gaza. Only the memories that one can have. The things that the staff give you in gratitude, it’s very likely that they’ll take it from you when you leave. I don’t know the reason. Nothing leaves Gaza.

Fortunately, I was able to take out certain things. I was able to take out a keychain that had a very profound message. Many will think it’s just a keychain. It was given to me by a patient whose son we discharged with severe malnutrition, and she told me, “Don’t forget us, doctor, don’t forget us.” Obviously, I wasn’t going to forget her, but I kept thinking, why does she have a keychain? There are no souvenir shops left in Gaza, why does she have a keychain? Where did she get it? Did she buy it for me? Was it given to her? Was it from her house? I don’t know. So that keychain was very special to me. Fortunately, I was able to take it out.

But getting back to the point, leaving Gaza is more impactful. Seeing the green agricultural fields that exist in that area, seeing the water irrigating them, the paved streets, the latest model cars on the streets, the parks, the families enjoying those parks… But above all, I think what’s most felt is the silence and the calm. They’re two different worlds, two different realities, only divided by a five-meter wall.

You told me something that stuck in my head, and I’ve tried to reconstruct it with my imagination, nothing more. You said that in those three suitcases, every time you’ve entered, you’ve also tried to bring in toys for the children.

Yes, we tried to bring in toys, since it was a prohibited item to bring in. There are items for civilian and military use, items which cannot be brought in. Among them are wheelchairs, external fixators for fractures, paper. Paper is no longer on the list, but it was on the list for a while. We didn’t have paper to print patient records. That really struck me: toys for children. Why are they prohibited? What military use can be given to them?

[rel2]

Let’s go back a bit to the conditions in which you’re working. Because we’ve seen that hospitals have been bombed. You said that there is no safe place in Gaza. So, where do you live? How do you live? In what conditions are you working?

That’s right, there’s no safe place in Gaza. And we have a base, it’s a house where we all live together. That’s exactly where I took the photo in the humanitarian zone. But yes, there is no sense of security. And that causes me a bit of conflict within myself regarding our local colleagues: It’s a sort of shame over this privilege of living in this humanitarian zone, of that feeling of security, and above all the privilege of leaving, which they cannot.

You mentioned your Palestinian colleagues who are there every day working alongside you, but who have lost 14 family members. How can one work like that?

It’s very difficult and it’s part of this trust, this bond, that’s created with them. When a week hadn’t even passed since I arrived, one confessed to me, “Homero, when all of this in Gaza started, I went to look for water and at that very moment a bomb fell. When I returned home, I realized it was my house, and all 14 members of my family died.” As if it were something normal, as if it were something simple to tell. Most of them, obviously, have very, very sad, heartbreaking stories. Being in Gaza has left an impression on me. It’s a mix of emotions —anger, compassion— but I also think a lot of admiration for the local colleagues, and how they continue despite that. One of them once apologized to me because his shirt was dirty. He said, “Sorry, Homero, it’s the only one I have since I left Gaza. I wear it every day, and yesterday I couldn’t wash it.” I told him, “It’s nothing, why are you apologizing? Don’t feel bad about it. The last thing on my mind is your shirt being dirty. You’re here, and that’s what’s important.” The level of commitment they have to their community is… wow, it’s something that impresses you.

We talked last time about the trauma of losing your entire family. These losses are recent. They probably had them in previous military operations too, but they cause traumas that would probably make it impossible for them to work in health anywhere else. Even for you, it must leave a psychological scar that might be an obstacle elsewhere. But no-one in Gaza doesn’t have them. I was thinking, Homero, since you’ve been talking with your colleagues so much. You leave and they stay. Israel doesn’t allow them to leave, and if there’s no safe place, they have no escape. Not even hospitals are safe. How can people in those conditions have any notion of a future? Or are they simply living on autopilot waiting for their death?

Yes, that’s exactly it. We offer mental health assistance for them, and they tell me, “Thanks, but I don’t have time for this.” If I start to get ideas, to think that this is really happening, I won’t be able to. Right now I’m surviving. And that’s what keeps me here. I’m going to allow myself to read it again, because one of them arrived very stressed at a meeting. When I saw him, he was very nervous and anxious, more so than usual. I approached him and said, “Do you want to talk?” He said no, but even so, I knew that that night his block, the place where he lived, was under an evacuation order. In a matter of hours, around two or three in the morning, he had to leave. He grabbed his family, his children, his mother in a wheelchair, amidst the rubble as best he could, and with only the clothing on his back. He told me, “Homero, I lost all hope in humanity. I don’t know what will happen to my life and the life that awaits my children — if they even have one. I don’t know what the future holds for me, but I want my children to at least have one.” And this made me reflect, because we hear in his words how there’s so much despair, but there’s also a certain hope. And in these situations, I believe they cling to that to press on. That’s valid; otherwise, it wouldn’t be possible.

It’s impossible to indiscriminately bomb an entire population without first dehumanizing it. The population of Gaza is absolutely dehumanized. Part of what I admire about Homero is his dedication: not only to saving lives there, but above all, that it seemed so important to him to come not only to put a human face to this terrible experience, but above all to humanize it. I believe that here you have all our admiration, and I ask you to convey it to all your colleagues in Gaza as well. Homero, thank you very much.

On the contrary, thank you for being here, for listening to me, for being part of this testimony and this urgent call to solidarity, to not remain silent. Silence only prolongs this suffering, these injustices. For me as a humanitarian doctor, and for you as journalists, speaking, documenting, and denouncing go hand in hand. That’s why I believe that humanitarian medicine and journalism cannot be separated. They’re both acts of justice, acts of humanity, and acts of resistance.