‘A war wound is a biological archive of the time we live in. It creates a narrative that explains the politics of war which cannot be altered by the ruling elite’ –  Dr Ghassan Abu Sittah

Dr. Ghassan Abu Sittah, a British Palestinian surgeon is known to the world as a doctor who addressed the press standing behind a podium surrounded by a pile of dead bodies. He was the doctor who informed the world that amputations are being done having no anaesthesia. In the beginning of the war in Gaza, the entire world paid attention to his tweets and insta stories to get to know the chilling impact of war .

In a conversation with Outlook, he explains how war creates a unique biosphere that affects health beyond immediate injuries. He emphasized that the impact of war is not temporary but creates generational health issues. He explains how a war is different from a genocide which he believes is happening in Gaza now.  He explains how a war wound is different from an ordinary wound. Dr Ghassan who runs a clinic in UK currently lives in Beirut.

Q. As Indians belonging to a generation that have never witnessed war, our imagination of war is limited, but we know that war is not a temporary crisis. As a doctor, can you share your thoughts reflecting on your experiences in Gaza?

We -each of us- live in a biosphere; What I mean by biosphere is the ecology that is created by the biological, physical and the social environment that we live in. Our health is determined by the interplay between these social, physical and biological conditions that we exist. War alters that biosphere and creates a new one that re-shapes our health system. So, to give you an example, War, not only damages our health because of the bombs and the blasts, and the bullets but also by destroying the water and sewage treatment system. It Alters our health by spreading infectious disease and by impoverishing us. By tearing communities apart, it alters our behavioural patterns, which in turn determines our health.

These changes that are made by intense and prolonged conflicts continue, even after the war is ended, shaping and reshaping People’s Health; So that the  biosphere of War continues, even after the political end of the war. In an area like the Middle East, which is on a geopolitical fault line, where wars are continuous and intermittent, where you have these continuous wounds, that biosphere becomes entrenched and multi-generational. You can then refer to it almost as an endemic disease because it is a disease process that is geographically, entrenched, and that continues to shape People’s Health in that region.

Q. I remember you said that the current war is not anything that you witnessed in 30 years. What prompted you to say so?

This is nothing but genocide. It is an attempt to wipe out a people from a geographic location; Therefore what you witness is not just an attempt to injure people in the present times but an attempt to ensure that they have no future. So the destruction, and the dismantlement of the health system, the destruction of all of the components of the physical environment-  whether its water, sewage or habitat- It is to ensure that people have no future. The destruction of thousands of historically significant places, the destruction of cemeteries- so that they have no past holding them to that area of land. That is the first difference between a war and genocide. And that’s the difference between all of the wars that have been fought in the past and the one being fought in Gaza now.

Q.In a former interview, you said that every wound has a narrative on war. Can you tell us more about the politics of war wounds?

The narrative of a war is there in the wound inflicted by it-who has done it; who is fighting with whom-all the stories of the war are there in the wounds and those  wounds stay with the patient for the rest of their life. The wounds inflicted on Iraqi and Iranian soldiers during the Iraq Iran War in the first half of the 80s remain on the soldiers. Even though Saddam is gone, Khomeni and Reagan are dead and the people who fought that war are also dead, the narrative of a wound remains the same.

Sometimes that narrative becomes in contradiction with the political ideology or the political project of the current political discourse. Iraq and Iran have become allies, but it does not change the narrative of the war wounds. They remain the same and that narratives outlive the political projects that caused the war that induced the wounds.

The wounds of the South, the soldiers in Vietnam, who were fighting with the South Vietnamese Army, who stayed in Vietnam are a continuous reminder,  that they fought with the Americans. And that there was a component of Civil War in the Vietnam War. When the power dynamics changes, the ruling elite either celebrate or ignore those narratives. The narrative of a wound sometimes becomes an embarrassment to the political project. This is why I say that the wound will remain as a biological archive to the war that inflicted the wound.

Q.How contrasting this idea of war is from the one set by the Western world? We were taught that there were wars occasionally having peace time in between.

Yes. The idea is that the wars are temporal events starting in a given moment and ending in another-which is not true.  That temporality that they try to imply is actually not what we see on the ground. I am still now operating on the wounded bodies of victims of the war that has just ended in Lebanon. I still have wounded patients from previous Wars in Lebanon. Their wounds still need further care. The idea of temporality that the humanitarian sector tries to push as where you land and you do the war and then you leave is untrue. This is how the Western narratives try to justify Wars. They set the narrative that wars start on a day, end on another and there’s no lasting effect, but actually what we know that they alter this biosphere that the people living and that continues to injure.

Q. As you often emphasize that war goes beyond physical injuries caused by gunshots or missiles but it causes, malnutrition, stunted growth and other generational health issues . Could you reflect more on the broader impacts of War?

There are two issues related, the wounding, the physical wounding of the body creates a trajectory of the body, and therefore, that wounded body not only needs treatment and reconstruction and rehabilitation but also that the wounded body ages differently. The aging process of a person wounded in war is different from that of one who is not. We know from the medical records of veterans of War who aged differently compared to the unwounded.

Malnutrition associated with War affect the size of the brain of children. Malnutrition increases, the risk of diabetes, non-communicable diseases and also the risk of  multiple illness.

Other than that, a child wounded in war- on average- needs  8 to 12 surgeries. By the time they reach adult age, their body tries to outgrow the wounded part. Then they need further intervention. And so you realize that war rather than a temporary event is almost like a trajectory that sends the physical body and the health of the individual down to a different Health regime.

The literature from the American studies on the Veteran’s Health Systems shows that Vietnam veterans who had an amputation to their lower limb and who were wearing Prosthetics when they were young, after the age of 60/65, the majority of them were not able to wear a prosthetic because of the difference in aging process. The stump of their limb changes and its ability to hold the prosthetic changes because wearing a prosthetic affects the other side and causes arthritis in the other joints of the unaffected Limb. The growing body of a child or an aging body of an elderly are shaped by the wounds inflicted on them.. So it’s a life trajectory rather than a temporal event.

Q.While watching the war in the Middle East, we understand the application of new war technologies. What are the challenges it bring to the Medical professionals? I have read that there are people bought to hospitals with unusual type of muscle burns and injuries.

What we witnessed in Gaza is the massive use of chemicals like white Phosphorous. We have seen thermal baric bombs being used and these are bombs that don’t create shrapnel but just a firewall that engulfs the wounded and gives them massive Burns. There are quad copters too. The quad copters are small drones with a sniper. These quad copter drones are sent in to buildings. They’re sent into schools, to hospitals. They fire at children and at civilians and so we see all of these wounds playing out in this war. Those who are killed by these new weapons are  rarely accounted for because their bodies are pulverized beyond recognition.

Q. Can you elaborate on the scarcity of medical professionals and medical supplies?

This time because of the sheer scale of the attack, the health system is shattered. In Gaza, the health system had 2,500 beds at the beginning of the war. By the second week, there were 6,500 wounded. The system is overwhelmed by the sheer scale of the destruction , wounding and killing. There were direct attacks on hospitals as well.

That’s on one side. On the other side, what we see in countries like Lebanon and Syria and Libya is that unfortunately medical education system fail to reflect the frequency or the endemic nature of war injuries in our society. So these medical curricula and nursing curricula from the northern hemisphere are important.

An Iraqi medical student is not taught about how to manage a blast injury patient or a gunshot patient. Neither Syrian, Libyan or Lebanese medical students are exposed to this learnings though they have to treat war injury patients in their career regularly.

Q. Even organizations like MSF (Doctors without Borders) have limitations in addressing this issue?

 Because the scale is bigger. This needs to be recognized globally by all countries  so that they can introduce this kind of knowledge into their undergraduate system. They create medical syllabus, that is contextualized to the Surgical and Medical needs of their communities, just like in countries where there is an endemic tropical disease having medical knowledge on the same. In a country where there is tuberculosis or Malaria, medical students are supposed to know how to diagnose and treat it. But in countries where there is a lot of conflict and War and weapons wounding, the medical community does not acquire the knowledge to deal with it. This is a  structural failure of the medical education system in these countries.

Q. Your idea of developing a curriculum on conflict medicine becomes important in this context. You had been trying to establish the same in a couple of Universities. How is it going on?

We piloted this program in Yemen, Iraq and Palestine and we found that the medical students were very keen and very appreciative of that knowledge being introduced into Medical course. In this war, we started to offer it to Lebanese medical students too. Now we’re trying to get the financial support to spread it to the Palestinian medical schools as well as to Iraq and Syria.

Q. I remember you said that there is nothing called international community. Was it an expression  of desperation or you really mean it?

See what we have been witnessing in Gaza. This is the most televised genocide in the history of humanity. This is what we thought could not possibly happen. People now can see the kids being burned alive in Gaza. Can see the massive killings and the  starvation induced by these killings in Gaza. Yet there’s nothing . The response  of the western governments are only attempt to silence systems like the international criminal court. They are trying to silence the officials who have been highlighting the genocidal nature of the war. This idea of International Community was just a stick used for policing the countries in the south.

Q.You have recently given evidence in the international court of justice. Can you see any result?

It happened in January (2024). Even now there are Western institutions, including scientific institution and academic institutions refusing to use the term genocide. Even though the highest court in international law-the International Court of Justice- said, this is closely a genocide. Yet you have medical journals that won’t use the term genocide, you have scientific journals, you have Royal colleges of surgeons and Physicians who refuse to use the word Genocide even though we now have it as a legal term.

Q. What message do you have for the medical community in India in this regard? What do you expect them to contribute?

Indian medical educational system is very robust. They have expertise, institutions and the contextualized knowledge. They can contribute in training doctors from the Middle East. Because of the nature of the sheer, number of patients in India, the experience in working in an Indian Medical Institution is much more relevant to our conditions. Indian Surgeons can function in our situations unlike the super specialists in the West. The West has become so super specialized that if you take a surgeon from a teaching Hospital in the west, and take them out of that advanced context and place them in a war zone, they cannot function in a way that an Indian surgeon is able to.

Q. What is the current situation in Gaza? Is there anything left?

Ethnic cleansing is happening in the Northern part of Gaza.They are blowing up buildings- building by building, That families are hiding in. They openly say that they want to empty the northern part of Gaza. Bombing is going on. And that every time there is a new hospital opened, it is bombed. We hear about such incidents over and over again. People die of even manageable wounds. People who have chronic illnesses get no treatment and they die. Children who have infectious disease which are otherwise curable get no medical care and they die. Now we’re going into the winter, we again have what we refer to as the Triad of death.

Malnutrition hypothermia and wounding kill people at lower levels of wounding, and lower levels of malnutrition, and lower levels of infection because the three are synergistic in their ability to destroy the human life. And so we, now again, have these mechanisms of genocidal, killing Beyond the bullet, and the bombs.

Q. Amidst all Horrors, there must be some stories of hope- stories of love, compassion and resilience. Is there something that you want to share with us?

Indeed. In the midst of all these horrors, people’s love for each other becomes a sign of resistance against the death machine. We see this in the sheer dedication of the doctors towards their patients too. There are doctors who insist on staying in hospitals. We see it in these families helping each other. In the few minutes bombing whoever left with injuries try to dig up the body’s and try to save lives. These are all acts of rebellion against the killing machine of the Genocide.

In Lebanon, I had a two year old boy who had an amputated arm, his mother, father, and grandparents were killed. His nearest relative was his father’s aunt. She came and stayed with him in the clinic and she had become his mother . You realize that humanity is going to be saved through such acts of love.

Q. Do you have a travel ban? Is your family safe?

They are still trying to remove my medical license in the UK. They’re still trying to have me banned from holding office in any charitable organization, in the UK, they campaign to silence those who speak against the genocide. They are trying to cancel the licenses of over 60 doctors in the UK. My family is like every other Palestinian family. They are part of this war.

 Q. When you look forward, what is next for you?

The future for me, that I dream of is being able to go back to Gaza and help rebuild the health system.

originally published here