I have known Ghassan Abu-Sittah since his time in Beirut as the Head of Plastic Surgery at the American University of Beirut’s Hospital. When we were first introduced, and given the number of Lebanese women that walked around with a band aid on their nose, I was a victim of a stereotype that made me think that Plastic Surgery could only mean providing ‘nose-jobs’ and the like. I began wondering how it could possibly be that a surgeon from Gaza, who immediately comes across as well-read in radical political theory, and likes to frequent social scientists, spends his time aestheticizing the noses, ears and faces of Lebanese women. Then he started talking about his work and it didn’t take me long to become introduced to the world of limb replacements and reconstructive surgery. I learnt that he spent a lot of time in Gaza operating on people maimed in awful ways by Israeli soldiers and their ‘sophisticated’ weapons and ammunitions. I also learnt that part of his work in Beirut consisted in operating on Iraqi soldiers maimed by the many of Saddam Hussein’s wars and the American invasion of their country.
We’ve stayed in touch on social media and we always come across each other when we are both in Beirut. He and his wife are both from Gaza and he has always worked in hospitals there amidst the many violent Israelis incursions into the territory over the years. So, it didn’t surprise me that he would immediately announce that he is going to Gaza when the Israelis started their retaliatory pounding of the strip in the aftermath of Hamas’ October 7 attacks.
As the retaliatory pounding turned into the most savage, premeditatedly indiscriminate and brutal mass murder of civilians in the first quarter of the twenty first century, and as the Israeli bombing targeted the whole social, cultural and medical infrastructure of the strip, the bombing of hospitals became a particular cause of attention and outrage. In this environment, Ghassan and his social media descriptions of working conditions inside the hospitals and the kind of surgery he had to perform, especially as hospitals ran out of anaesthetics, started to widely circulate. He was increasingly being interviewed in the mainstream media and is now preparing to be an eyewitness at the ICC in the Hague.
Recently, we caught up over a cup of coffee at Café Younes in Hamra, Beirut. He had lost a lot of weight. He told me that he was suffering psychologically and physiologically in the aftermath of his Gaza experience. He also feels a sense of guilt for having left and would have liked to go back if it didn’t involve subjecting his family to all the fears and uncertainties that going back to Gaza would involve. Already his wife’s father has disappeared in Gaza more than a week ago, so she’s dealing with enough as it is. Insensitively perhaps given the above, I tried not to let all this come too much in the way of my curiosity. I wanted to hear from him some details of his everyday life as a surgeon working in the midst of destruction and mass murder. So, I was probably unbearably inquisitive, raising way too many issues. But he indulged me, and answered my questions.
We often argue that thanks to social media, and to some heroic journalism, Gaza’s destruction and the killing of its people have been made available for all of us to witness more than any destructive murderous war before it. While this indeed gave us an unequal proximity to the destruction and the killing, it did not give us proximity to the way this destruction and killing is lived and negotiated by those experiencing it. My questions to Ghassan were particularly directed at getting some insights into the nature of surgery as a practice in such conditions. How do the medical staff perform their tasks under such circumstances, how do they relate to their own bodies being endangered, how do they relate to the horror that surrounded them and how do they relate to each other? I also quizzed him about what kind of solidarity, but also what kind of tensions arose between the staff in such circumstances.
At one point I raised the fact that in the public imagination surgery is often associated with ‘cool hands’. How was it possible to have ‘cool hands’ amidst the falling bombs, crumbling walls, depleted medical resources and malfunctioning technology? I asked. Ghassan said this was all nerve wrecking indeed. And particularly nerve wrecking was the flow of dead and injured people one encounters at every moment; sometimes in incidents happening before one’s very eyes. He kept referring to ‘the freshness of the wounds’ and the kind of interaction with the body of the injured that such ‘freshness’ required. Paradoxically, all this, he said, gave the performance of surgery itself a therapeutic function, so there was never a problem with your hands not serving you.
As he explained, in the chaotic conditions of mass destruction and mass murder, there is a reversal between what, in a ‘normal’ (ie, peace-time) hospital space, is considered as ‘the space of tension,’ and what is considered as ‘the space of tranquility’. In those normal conditions the world outside the surgery room is the world of calm while the tension is happening in the operating room. This is reversed in Gaza. With the world outside the surgery room being extremely dangerous and tense, the performance of the familiar practices associated with surgery transform the operation for the surgeon into a kind of relaxing ritual: the person they are operating on becomes flesh rather than the daughter of x or the brother of y, and the technicality, predictability and ordered nature of surgery stands in opposition to the chaotic outside.
The above, ordered, a-personal, and ritualistic character of the surgery itself stood out particularly in comparison with the socially far more difficult pre-surgery decisions concerning triage: choosing who to prioritise for surgery among the many injured. This created a continuous ‘Sophie’s Choice’-type reality, Ghassan said. And it was made complicated by situations where medical staff would recognise people personally, he stressed. I initially thought that he was speaking of those difficult moment which many of us had already seen on social media where medical staff recognise close kin among the dead and injured. But this was not what he was referring to.
He said that while triage is usually done on the basis of a purely medical assessment of the viability of the operation: who needs it most urgently, and who is likely to survive it and benefit from it. In Gaza, and because the medical staff sometimes recognised who the injured people actually were, an added criteria was people’s knowledge of how many of someone’s family had already been murdered by the Israelis. Someone would say: we must try and prioritise saving this one, three of his or her siblings have already been killed and s/he is the only one left for his/her mother.
I found this extremely important, because it is a point that transformed the practice of surgery from a relation between a surgeon and the repairing of an individual body into a relation between the surgeon and the repairing of social relations. If the aim of genocidal violence is not only the destruction of individual bodies but the destruction of networks of social relations and their capacity to reproduce themselves, surgical practices, by aiming to save or repair family and communal rather than just individual bodies in the way it is described above acquire an important anti-genocidal dimension. Ghassan said a number of times that the environment created by the Israeli bombing kept bringing Achille Mbembe’s notion of ‘death world’ to his mind. It seems that in Gaza’s crumbling environment, the hospital gives new meaning to the notion of ‘life world’, highlighting it as a form of resistance to the expanding ‘death world’.
There is a particularly special and close relation between health practices and anti-colonialism in Palestine that is not as pronounced in other anti-colonial struggles, Ghassan tells me. Perhaps this is because of the intensely genocidal disposition of Israeli colonialism towards Palestinians. In places like South Africa, Apartheid was structured by the need for a healthy labour force and hospitals performed a useful colonial function in this regard. In Palestine, while the Israelis do make use of Palestinian labour, this usage is neither important nor crucial. There is no vested interest in a healthy Palestinian population, quite the contrary. As such, the exterminatory tendencies of Israeli colonialism can more easily run amuck as it were, especially when they are well-financed and well-armed as we have seen it happening over the years, and as we continue to see it happening in Gaza today. It makes all practices of preserving health anti-colonial by definition. The insistence of Israel on demolishing hospitals acquires a different dimension when seen from this perspective.
This puts us face to face with the other therapeutic dimension of what we do in the hospitals, Ghassan says. I told you about the therapeutic function of the surgical practice as a ritualised, ordered work of relating to the flesh of the injured. It can be seen as a therapy provided by the micro dimension of our practices. The therapy I am now referring positions us on a different scale. It comes from a relation to the macro socio-political dimension of our practices. It comes from the knowledge that what we are doing is part of an anti-colonial liberation struggle. Not in the darkest of moments, when the bombs are falling at their most intense, and when the flow of the dead and injured is at its most severe and when the morale is very low, do we lose sight of the horizon of liberation.
