This American is one of the few allowed into Gaza. This is the horror she saw

Very few people are allowed to enter Gaza right now. Dr. Seema Jilani, an American, is one of them.

She spent two weeks working at a hospital there and witnessed horrors play out before her. She recorded voice memos in between treating patients and shared them with NPR.

And a warning: The descriptions that follow from those voice memos, and from her interview with NPR on Wednesday, include graphic scenes of violence and suffering.

It's been nearly 100 days since the deadly Hamas attack on Israel, which prompted Israel's ongoing bombardment of Gaza.

Israel says it aims to destroy Hamas. By Palestinian officials' tally, more than 23,000 Palestinians have been killed in Gaza, and about one in every 40 people there have been wounded in just three months.

Israel's military is now pushing deeper into central Gaza, and says Hamas uses hospitals as command centers. The World Health Organization says the most important hospital in central Gaza is al-Aqsa.

"I've seen a lot, and I never compare conflicts, but that's got to be the most nightmarish thing I've ever seen. And the most, one of the most, inhumane and cruel things I'll ever see," Jilani says in a voice memo about an 11-year-old girl in the emergency room at al-Aqsa who was severely burned in an explosive blast.

"To look at her, [there] was an infinite waterfall of pain coming out from her. It's the stuff of nightmares."

Jilani worked in the emergency room for two weeks with the International Rescue Committee, in partnership with Medical Aid for Palestinians, bearing witness to agony again and again.

"Children lying on the ground, double amputation on one child," she says in one recording. "And there are no beds available, so people are literally just on the ground seeking treatment. There's not really room or space for us to breathe or think. And then there's one, two, three, four ... six children in my line of sight right now from the corner that need medical attention urgently. One of whom is crying, a little boy around six or seven years old, wiping his tears."

Jilani describes a hospital on the brink of collapse, including 500 patients arriving in just one night. And those patients were showing up at a facility desperate for supplies. She had no morphine or portable oxygen to give people.

"I've always told myself, there's not much we can do in medicine, but we can treat pain. And it's no longer true anymore," Jilani says. "So we cannot even offer any comfort here. There is no death with dignity when you're lying on the ground of an emergency room in Gaza."

All of this is playing out while the hospital is surrounded by bombing and gunfire. Now Doctors Without Borders and the International Rescue Committee have evacuated medical personnel from al-Aqsa hospital because of increasing Israeli attacks in the area and evacuation notices to neighborhoods there.

The United Nations reports that just three doctors remain to treat hundreds of patients. Jilani spoke with All Things Considered host Ari Shapiro on Wednesday from Cairo about what she witnessed.

This interview has been lightly edited for length and clarity.

Interview highlights

Ari Shapiro: I imagine that when you recorded those voice memos, you were very focused on the tasks right in front of you. And so what's it like to hear them now in a place where you have a little more room to think and breathe?

Dr. Seema Jilani: It feels that my mind, my heart and my spirit is still in Gaza, and my body is somehow in Cairo, and then we'll continue onwards to where I call home. And it feels inherently wrong that I'm allowed that privilege and others are not because of the luck of where I was born.

Shapiro: You've worked in many conflict areas: Afghanistan, Lebanon, Gaza in 2015 right after the Israeli ground invasion. And we heard you describe this experience as the most nightmarish. How is it different from other wars where you have worked as a pediatrician, as a doctor?

Jilani: You know, as a pediatrician, I didn't think I would be very useful. Because this is war, and in war I would imagine and think that the victims or the war-wounded or the killed would be predominantly young men. I can say that on one day in our code resuscitation room, out of our five patients, four were children. And I'm very sad and deeply disturbed to say that I was very useful as a pediatrician in a warzone. And that should never be the case.

The second way in which I find it extremely different is that in war we often talk of the fall of cities — the fall of Mosul, the fall of Saigon — and somehow I wonder when it was normalized that we are now speaking of the fall of hospitals — the fall of Al-Shifa, and now the fall of al-Aqsa hospital — crescendoing all the way south to Rafah. And we expect it, and we're now giving deadlines to when we anticipate the next fall of the next hospital as it rams its way through Nasser and perhaps European Gaza hospital. And we're continuing to watch the landslide as voyeuristic onlookers to grief.

Shapiro: Can I ask you about one patient who you told us about in a voice memo. You explained he was a man in his early 20s, who worked for the U.N., he was brought in still wearing his vest with the logo of the United Nations Relief and Works Agency. And both of his legs were severed. You couldn't offer him morphine, and it was clear that he was dying. So you took a little piece of gauze and wiped the blood from his eyes and gave him some water. Here's what you told us in the voice memo:

"The way he just calmed down when I was just putting water to his lips, told me everything I needed to know. His ask was so his little, was so tiny, and that's all he needed. He just needed some comfort, someone to bear witness, someone to say, "Yes, you're in pain." Someone to say, 'This is not OK.' Someone to help clean him up and make him feel like a human being."

You said the best you could offer him was a quiet place to die, but in al-Aqsa hospital, you couldn't even provide that. What does that experience with that one man say about the situation across Gaza right now?

Jilani: All he had when he died was my hand in his hand. And the only comfort I could provide him was wetting his lips with some makeshift gauze and some salty water, which was actually saline, which we usually put into IVs. I think it's a testament to how we have failed the people of Gaza. And I only wish I could do more.

But the way that he reached up and shifted his neck as I stroked his hair, just the human connection there I'll never forget, and it will be one of the most rewarding memories I will take with me. That no, I wasn't able to give him what he deserved. I was able to stroke his forehead with a wet washcloth, whisper some words of calm, maybe a little sweetness, get some wetness of water on his tongue as he lifted his head to meet my fingers. And none of those interventions are morphine. And at the end of the day, he died on the floor of a Gaza emergency room with little more than my hand in his.

Listen to All Things Considered each day here or on your local member station for more interviews like this.

Shapiro: There was one detail from the voice memos you sent us that stuck with me. And I'd like to play this for you:

"I'm questioning how much of a difference am I really making. It's such a proverbial drop in the ocean of blood. Yesterday, I noticed — there are a lot of flies here — and there was a fly that had drowned in the blood of a patient. And I just thought, wow, it's just literally a river of blood here. It's so much that insects are drowning in the blood of my patients."

Can you speak to what medical professionals are actually able to do in the hospital in that horrific situation? I mean, is a doctor in an overcrowded hospital with no morphine, no gauze, an ongoing bombardment, actually able to make a difference to patients?

Jilani: I believe so. I believe it means something when I'm holding a gentleman's hand and he's dying and he's looking at me in the eyes. And I think that's worth something, otherwise I wouldn't be doing this. And I think it means something to the doctors there to see us in solidarity with them. Gaza is a space that is hyper aware of the political situation outside and the forces that exist outside of it, and they feel forgotten. And the moment they see someone standing with them and offering support to them, not even in a material way — in a symbolic way to say, "We are here to see your patience while you mourn the death of your friend or your family member" — it means something. And it certainly means something to me.

And I think it's worth holding space for that, however little that feels. Some of those things are intangible, but they're not intangible to the ones that are feeling it, that are soaking blood through their clothes. They're not intangible to the mothers that are having to bury their children. And they're not intangible to the orphans whose heads I've held in my hand.

Shapiro: If you're able to go back, will you?

Jilani: Absolutely. Unquestionably.

Shapiro: You say that so unequivocally. Tell me more.

Jilani: I've been anchored in this conflict for over 18 to 19 years. The people of Gaza occupy a place in my heart. Their resilience, their incredible ability and tenderness, their invulnerability that they are able to tap into. Every time I go there, I feel that I learn more than I give. I am completely blessed and grateful to know the people that I have gotten to know there as part of the staff and my patients and the nurses. And I will take lessons from each of those people and hope to bring them to my profession, to my family and show them this is how a life well lived, this is what it looks like.

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