From Beirut to Jerusalem 1 Journey To Beirut Summer 1982 Ch 1 -5

 From Beirut to Jerusalem 

Ang Swee Chai 

“…an eyewitness account of the massacre that cuts through the cottonwool to go to the 

very heart of the matter.” − The Guardian 

   

 

To the Palestinians and their friends… 

   

  

   

Contents 

Acknowledgements 

The Wounds of Gaza 

Introduction 

PART I : Journey To Beirut  Summer 1982 

Chapter 1 

Chapter 2 

Chapter 3 

Chapter 4 

Chapter 5 

PART II : The Sabra – Shatila Massacre Autumn 1982 

Chapter 6 

Chapter 7 

Chapter 8 

Chapter 9 

Chapter 10 

Chapter 11 

Chapter 12 

PART III : From Jerusalem To Britain 1982-1984 

Chapter 13 

Chapter 14 

Chapter 15 

Chapter 16 

PART IV:  Return To Beirut Summer 1985 

Chapter 17 

Chapter 18 

Chapter 19 

Chapter 20 

Chapter 21 

Chapter 22 

Chapter 23 

PART V:  From Beirut To Jerusalem 1985-1988 

Chapter 24 

Chapter 25 

Chapter 26 

Chapter 27 

Chapter 28 

Chapter 29 

Chapter 30 

Chapter 31 

Reflections on the 25th anniversary of the Sabra-Shatila massacre, 2007 

   

Acknowledgements 

Writing this book has been no easy task: it has involved my going back over the past six years, reliving certain very painful memories and reopening old wounds. I want to thank Steve Savage for his patience, support and encouragement; as well as his editorial advice, without which this book would be totally unreadable. My thanks also to everyone else at Grafton Books.  

As well as the MAP volunteers, supporters and staff who are mentioned in the book. I want to thank those whose names are not in. either for reasons of personal safety, or by their own choice, or just from lack of space. It is they who are the true friends of the Palestinians. It is they who slave away so that the medical programme can continue.  

My fellow MAP board members, who have had to put up with me ever since we were formed, especially Major Derek Cooper, our President, and his wife Lady Pamela. David Wolton, our Chairman, and Dr Riyad Kreishi, the acting Director of MAP during Dr Rafiq Husseini’ s absence – I thank them for their enormous contributions to my understanding and their much-valued guidance.  

The Palestinians always try to thank their friends. Now I want to thank them for being so strong, for being a constant source of inspiration to me, especially in the depths of despair. Above all, I thank the Palestine Red Crescent Society, for all it has taught me, and for making me, I hope, a better doctor and human being.  

I also thank my Jewish friends who encourage me to speak up and not be fearful.  

My parents and family in Singapore, whom I have postponed seeing for years, I am grateful for their patience and forgiveness. Francis Khoo, related to me incidentally by marriage, I have to thank thrice. First, for his untiring efforts in bringing MAP to birth. Second, for his advice and criticism during the writing of this book. Third, for not putting me out even though I caused him many anxious and sleepless nights while I was out in Beirut.  

Professor Jack Stevens, Alan Apley, J. M. Walker, R. C. Buchanan, Fred Heatley, Tom Wadsworth, Ian Pinder, Jo Pooley, Peter Robson, Ron Sutton, Kevin Walsh and the rest of my senior orthopaedic colleagues and teachers who not only trained me, but fought the prejudice of the surgical establishment against small coloured women becoming surgeons, making it possible for me to pursue a career in orthopaedic surgery.  

Lastly, thanks to many people from all over the world who continue to live in faith, hope and love. Without them, this journey from Beirut to Jerusalem would not have taken place.   

The Wounds of Gaza  

I returned to Gaza in January 2009 when it sustained the worst attack since the Six Day war in 1967. The Christmas week of 2008 was rudely interrupted by shocking scenes of Gaza being bombed by land, air and sea. In just three short weeks, 1,400 Palestinians were killed, nearly half of them children. In this tiny part of Occupied Palestine, there were 5,450 casualties, severe enough to require operations; many remain in a critical state today. Over 21,000 homes were destroyed, 4,000 of which were flattened to rubble by the deployment of implosion bombs. Other buildings were not spared – 40 mosques, hospitals, clinics, schools, even United Nations warehouses. The scale of attacks matched that meted out to the Lebanon in 1982, or indeed, during the 2006 invasion, with similar intensity, ferocity and breaches of international law.  

I have known Gaza since the days of the first intifada, twenty years ago. Indeed, From Beirut to Jerusalem was written during the six months I had to spend waiting for the Israelis to grant my first visa into Gaza. A surgeon was urgently needed to treat the untold injuries sustained by unarmed Palestinians during that uprising, and I volunteered.  

The enforced wait proved productive; it enabled me time to pause my work in Beirut, produce these memoirs and then head for the Gaza strip when the visa finally came in 1988. I spent the next six months as the only foreign orthopaedic surgeon in the Anglican hospital of Al-Ahli in Gaza city.  

I first met Palestinians in 1982 when I responded to an international appeal for help following Israel’s invasion of the Lebanon. I was warned by my Church these people were ‘terrorists’ and the Philistines of the Bible. In the refugee camps of Beirut, however, I found camp people who were warm and generous and who kept telling me of a home their young had never seen. Of a place called Palestine they were forced to flee in 1948. And of their determination to return one day. From Beirut, they would return to their Jerusalem. That their wish to exercise their right of return remained undimmed through the passing years and that the Palestinian nation was indivisible. Those in the diaspora was one with those under occupation.  

They told me the hospital they named ‘Akka’ in Shatila camp was to remember the coastal city many came from. And 

‘Gaza’ the hospital in Sabra camp I worked in was named after the tiny strip of land just 147 square miles in Palestine.  

In September of that year, thousands of unarmed men, women and children of the camps were massacred in Sabra and Shatila. That massacre forced me to acknowledge Palestinians existed and their story of exile was true. This book was written in dedication to those who died and to all survivors who remained steadfast in their determination to return to Palestine. 

I returned to Beirut many times and was there in 1987 when news of the Intifada emerged. Palestinians rose up in an uprising of civil disobedience against the Israeli occupation of the West Bank and Gaza. The Israeli army responded brutally to put down the uprising. Many of my friends in the Lebanon were anxious for their families who remained behind and did not flee in 1948 and 1967. But they were also proud it had finally happened after decades of occupation. I told my friends I would go to Gaza and promised to report back on a Gaza most of them had not seen.  

They were full of hope that morning in 1987. The Uprising was a declaration to the whole world of the refusal of Palestinians in the West Bank and Gaza to live under Israeli occupation. TV coverage worldwide showed Palestinian children confronting Israeli armoured cars and tanks with stones. Women and old folk were not afraid anymore. It was David and Goliath, my favourite Bible story.  Occupied Palestine was telling the world, “We will die standing; we will not live on our knees”. Their courage captured the sympathy and imagination of the world.  

To crush the Uprising, tear gas was fired into unarmed demonstrations, into homes, schools and hospitals. ‘Plastic’ bullets and ‘rubber’ bullets were fired at very close range into the eyes and heads of demonstrators, causing blindness and death. Israeli soldiers were filmed on TV beating a captured Palestinian to death. As Yitzchak Rabin, the then Prime Minister boasted openly that when Israel was through with the Palestinians, they will be a nation of cripples.  

Because of the large numbers of casualties, the UN asked for an orthopaedic surgeon. I responded and left the Lebanon for Gaza a year later. Despite UN sponsorship, Israel took six months to allow me in.  

I remember how I first heard of the news of that uprising. 

I was on a routine morning round with ‘Mamma’ Rita, an 80 year-old retired German ambulance driver and paramedic who volunteered with our charity Medical Aid for Palestinians. We were doing a daily morning milk round, providing milk, basic medical care and advice for the homeless in Beirut. Each family was partitioned from the other by a blanket and had to contend with a living space of 3 metres by 3 metres. Thus a small basement garage was shared by dozens of families. You could smell the overcrowding. I remember that December morning in 1987, wet, cold, dark and damp. The floors of the shelters were flooded; there was no electricity and running water. Here you saw despondency and their sense of helplessness was palpable.  

The intervening years gave no respite to the suffering of the people of the camps who survived the massacre. Indeed, their conditions deteriorated and morale sank to a low. These were people who had little to look forward to, the children had lost their smiles and laughter, their homes were destroyed in the camp wars of the mid-80s and many families were sheltering in abandoned car parks and basements.  

But that December morning, something was different. Glued to their radio, they heard the first news of the Intifada. Explaining in broken English to me, I saw a sparkle in their eyes as they spoke of the Intifada. Their smiles began to return. They were beginning to regain their dignity.  

They told me their grandparents said Gaza was very beautiful. They could only imagine and dream of going to live there one day. They were told of the olive and orange groves and the blue Mediterranean sea. The wanted me to confirm Gaza’s beauty. They were indeed correct; Gaza, despite the suffering and devastation, is a truly beautiful place. 

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In the course of that first Intifada, hundreds died, thousands more were injured and tens of thousands imprisoned.  

I worked in the Al-Ahli hospital in Gaza city. It was a small hospital founded in 1891 by Christian missionaries and was the only independent medical centre not under Israeli control at that time. In all the other Israeli controlled hospitals, wounded Palestinians brought in for treatment were open to scrutiny and subjected to arrest. Doctors had to report stone throwers shot by the Israeli soldiers. It was understandable why wounded demonstrators preferred the security of Al Ahli.  

As we refused the Israeli Defence Force automatic access to our hospital, we were hostilely treated. If they wished to arrest one of our patients, they would surround the hospital with armoured vehicles. Soldiers would take up positions on our rooftops pointing at us with loaded automatic weapons, ready to snipe into the hospital. Indeed, my clinic was shot into. Ground commandoes would advance into the hospital. Sometimes soldiers would storm in while women were in labour.  

On one such occasion, I was finishing an operation on a patient who was shot in the shoulder. Soldiers marched straight into my operating theatre – guns and all – and demanded I surrendered him for interrogation. I refused to let them do so. Taken aback, they promised to return later to take him once he recovered from his anaesthetic. They had probably never had to contend and row with aggressive Chinese women before!  

They did return that night but could not find the patient. Except for the foreign doctors’ rooms, the whole hospital was searched to no avail. My foreign anaesthetic colleague had hid him in his room. Our patient escaped but the hospital saw no end of harassment for the next few days. But the staff continued to plough on, treating and operating on more and more wounded.  

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The entire Gaza Strip was regularly put under curfew. These curfews were prolonged and often lasted for weeks on end. Children were locked up in their homes and not allowed to go to school. They were not even allowed to look out of the window. They risked being shot at if they did so.  

May 1989 was an abnormal month for me. Israel was celebrating its Foundation Day and placed the whole of Gaza under military curfew. I was out in Jerusalem to buy medical supplies and, as a UN official, was exempted from the curfew. As I drove through, I saw how Israel was decked out with blue and white flags, and preparations for celebrations were well in advance. There was an atmosphere of gaiety in Israel but as I advanced back into Gaza, my heart was heavy. Gaza had remained silent, like a ghost town. There was a curfew, no music was allowed, no one was allowed out of their homes. My ambulance was the only moving object as I drove through Gaza city. It was eerie.  

I remember only too vividly 6 May, 1989, a day of blood. It was Eid – the ending of the Muslim fasting month of Ramadan – and it was usually a time when everyone broke their fast, visiting each others’ homes, showering gifts and offering well wishes. But as worshippers emerged from their mosques, Israeli helicopters appeared and started firing live rounds at them. Children and young men angrily responded by stoning the ground Israeli soldiers. They responded by shooting back. In that few minutes, 343 injured Palestinians were brought into our tiny hospital and 6 of them died while awaiting treatment. We operated on the wounded all day and throughout the night and into the next morning. As I emerged at dawn, I was told to go off for a shower and have something to eat.  

It was then that I had a distinct sense of deja vue. At 7.00 AM, 18 September, 1982, years before, I was ordered out of the basement operating theatre of Gaza hospital in Beirut’s Shatila camp. I walked into the bright sunlight and learnt the truth and scale of what happened over the previous three days. I was a witness and survivor of the Sabra-Shatila massacre.  

But on that 6 May 1989 morning, something was different. As I left the hospital operating theatre that morning, the tree in the hospital courtyard greeted my eyes. Overnight it had put out pink blossoms. Against the bright May sky, it looked bizarre and beautiful. When I reached my quarters on top of the hospital pharmacy, I knelt down and burst out into sobs. Memories of that earlier massacre in Beirut and what I experienced the night before in Gaza and my six months there overwhelmed me.  

The tear gas and the shootings, the sheer humiliation forced upon families, the open cess-pools, the realities of life under occupation. “God, are you still there?” I asked. But then I looked out of my window. The tree in full blossom seemed to tell me that He had not forgotten. Spring was in Gaza, as beautiful as it always was.  

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When Israel withdrew its settlements from Gaza in 2006, it created a large prison for all one and a half million people. It put Gaza under military siege. No one was allowed to enter or leave Gaza without Israel’s permission and a blockade arose. 

Visitors, especially those from the West, usually visit the West Bank and tend to bypass Gaza. It was for a start, logistically difficult, given the extra security ringed around Gaza by the Israeli army. Personally I had spent hours at the Israeli Erez checkpoint trying to gain entry into Gaza in the intervening years. Likewise there was no guarantee I could get out at a chosen time after each visit. This belied the myth that Israeli withdrawal at that time gave Gaza unprecedented freedom. Many westerners also believed Gaza was poor and uninteresting and teeming with Islamic zealots and suicide bombers. This belief is untrue. 

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When the latest attack on Gaza started in December 2008, Dr Ghassan Abu-Sita, a young Palestinian surgical colleague of mine in London, became concerned about the level of destruction and the fate of his family. Ghassan comes from a distinguished Gazan family and was desperate to go there to assess the medical needs and plan for long-term medical help. While we were both surgeons, we realised our role was not to perform operations – Gaza had superb and skilled local Palestinian surgeons. What they needed was medical supplies and further training. We wanted to know what the best way of supporting them was.  

Throughout the 22 days of bombardment, Gaza was hermetically sealed off by Israeli troops. We figured that we had a narrow window of opportunity to get into Gaza from the south, at the Egyptian-Rafah checkpoint. The normal entry through Israel was hopeless as too many visitors found to their cost. But the Egyptian side in the south also proved difficult as Egypt could not open the Rafah crossing without Israeli authorisation. Our hunch was correct. As we had anticipated the Israelis declared a temporary unilateral ceasefire on the eve of President Barrack Obama’s inauguration. The Israeli general election was also due to take place soon. We left London for Egypt.  

The road from Cairo to the border at Rafah was punctuated by at least ten Egyptian military checkpoints. Despite many of them being unmanned, it still took more than five hours to reach Rafah. Along the route, various trucks heading for Gaza were turned back. One of these was a truck with cement; building material was not allowed for Gaza. The bombed out hospitals, schools and homes must remain ruin and rubble. The crossing had just been open for doctors to go to do humanitarian work. A long convoy of trucks with medical supplies and equipment were held up in line at a separate goods crossing near us. Each truck’s contents were carefully searched, causing enormous delay.  

The British Embassy in Cairo warned us it was reckless to go and that we were going against the advice of the government. Everyone was nervous about the prospect of being allowed in. The previous day saw dozens of medical doctors turned away. So it was rather surreal that three hours of frustrating wait finally ended and we were waved on to the bus taking us into Palestine.  

Once we entered Gaza, it felt like a home-coming. The atmosphere was completely different. The Palestinians meeting us carried our luggage without wanting any tip and we had our passports stamped with Palestine entry visas. Thirteen Palestinian young men who wanted to leave Gaza were turned back by the Egyptians and were denied permission to leave Gaza. At least 25 Palestinians were denied exit permits to study abroad, despite all being awarded international scholarships to do so.  

A Palestinian health ministry liaison person came to meet us. We said we came from Britain to assess the medical needs of Gaza for a medical charity. He was very pleased and arranged an ambulance to take us to the taxi-stand at Rafah. That evening, Gaza radio announced that the first British medical team had arrived. Ghassan thought it very funny, what with him being a Palestinian from Gaza and I a Chinese. Fortunately, we were joined by Dr Sonia Robbins, a British plastic and hand surgeon, the next day. So, with her, we now had an Anglo-British component, a truly rainbow coalition.  

We stayed with Abdel Daim, Ghassan’s father-in-law who came to pick us up at Rafah. I had been on the road leading from Rafah in the south to Gaza city in the north many times during the first Intifada. I remember the road being crowded with buildings and shops on either side. But this time, as Abdel Daim drove us I was surprised the road was flanked by open spaces – fields and clear areas. It was apparent that since the second Intifada in 2001, many buildings were destroyed by Israeli military action. As Gaza had been under siege most of the time, rebuilding was not possible, so these clear spaces became fields over time. Further north, there were recent bombed-out buildings – heaps of rubble, collapsed concrete, mangled cables – the devastation of the latest invasion. This was very much like Beirut in 1982. And what Al-Jazeera TV in London was showing during the preceding three weeks – factories, schools, playgrounds, petrol stations, mosques and homes were bombed out and gone.  

I looked at Northern Gaza – how often have I driven down Sal-Uddin Road, the main road from Gaza City leading to the Israeli Erez checkpoint, in 1988 and 1989. I remember every turn and corner. I know the citrus orchards, the farms and the homes of people with beautiful gardens. Often I would stop my ambulance to give a ride to the farm workers and they in return would give me freshly picked lemons and oranges. I now see it completely laid waste by Israeli explosives. Northern Gaza 2009 resembled the nuclear devastation of Hiroshima after the Second World War. The entire area was obliterated.  “Look at our petrol stations!” Abdel Daim exclaimed. 

“Where?” I asked. There by the road-side was a man squatting. Surrounding him were several jerry cans – plastic containers for carrying water – filled with petrol instead. “From the tunnels”, remarked Daim. The tunnels also brought in food, medicines, cigarettes, Coca-Cola and other items. Ghassan bought a can of Coke still covered with tunnel sand.  

As he drove, Daim continued, “They pound us from the sea, shelled us from their tanks, bombed us with F16s and helicopters – they have killed and wounded so many. But they have not recaptured one inch of our territory. Welcome to Free Gaza!” Wow! I thought. What a defiant spirit. He went on, “I will not leave. If they want to, they can come and kill me on my land.”  

Yes. How can I forget? In the first Intifada, I spent six months with them and found the same steadfastness and courage. I had completed From Beirut to Jerusalem and wanted to share with them the story of their Palestinian relatives in the Lebanon. I had brought along only six copies with me but the nurses in the hospital carefully spliced the book into four or five sections and shared it out among the others so more could have access to the book. They were hungry for news on the Lebanon. While the Beirut hospitals were named after places in Palestine, those in Gaza, in turn, named their places after Telazater and Shatila, in honour of the refugee camps in the Lebanon. There is no better example than this to prove that the Palestinian people are one and indivisible, that there is no distinction between those under occupation and those in exile. 

Daim turned off the main road and into a narrow road with several pot-holes. On the one side was a cemetery. “You remember Mohammed – the little boy killed by the Israelis at the beginning of the Intifada? The picture of him being cradled in his father’s arms was seen on world TV. He is buried here as this is where he lived”. Beyond the cemetery were olive groves and destroyed houses still occupied by people. It was off the beaten track with donkey-drawn carts as the main form of transport. Yet everyone seemed to know Daim and they waved at him as he drove past.  

On the left side was a field with two peacefully grazing ponies. Yet another turn brought us closer to the olive trees. Daim pointed to a large field, “The Israelis came one night and destroyed all the olive and apricot trees on 60 dunums of land. Most of those trees were over 50 years old and planted by my mother. The area is named after my mother, Magbule, who dug the first well here. She came at the age of 17 years from Jordan to marry my father, the Municipal Judge in Khan Younis.” Daim later took us to the graves of both his parents on his farm and the grave of his olive trees. The remains of the olive trees were neatly piled together, the huge trunks reminiscent of those in the Garden of Gethsemane in Jerusalem. On his farm, even murdered olive trees deserved a grave.  

When we finally reached Daim’s home, flanked by palm trees, bougainvillea flowers, hibiscus, jasmine and honeysuckle, I found it difficult to believe such a beautiful garden stood in the midst of such destruction. An arrogant cockerel made his presence felt. But he was outdone by a peacock that fanned out his tail in huge grace and glory. “Oh, we have 30 of them in the farm,” explained Daim. The house is a bungalow with a flat roof top. I started to climb to the roof but was immediately stopped by Daim as there were Israeli drones (robot spy aircraft equipped with rockets and mechanical snipers) surveying the area. Anything that moves would be shot at. I did not need convincing as I beat a hasty retreat.  

Daim is a tall dignified Palestinian of about 60 with silver grey hair, moustache and long eyebrows to match. Beneath the stern appearance, was a kind man with a great sense of humour. He had been arrested and imprisoned four times, and although tortured, never betrayed his friends. He came from a Bedouin family in Beersheba and they were renowned for their strength and loyalty. The family was driven out and became refugees in Gaza. Aida, his wife, is a young looking and attractive lady, who decorated their home with beautiful Palestinian embroidery pieces. I first came across such embroidery in Beirut in 1982, in Shatila camp. Each village has its distinct motif. Women sat on the floor embroidering colourful and ornate motifs, each village distinct from the other. Despite the demolition of their villages, memory and heritage lived on through these colourful silk threads sewn on black cloth. It is very labour intensive, but soon I was able to pick the various motifs like the Star of Bethlehem, the Rose of Jerusalem, the Cedar tree, the Olive branch, and the rich red and orange of the Bedouin communities. Now in Aida’s home, I saw all these once again displayed on cushion covers, pictures framed on the wall, cloth covering tables, the sofas and wrapped around vases. The beauty of the embroidery and the garden brought to life the real beauty of Palestine. Diaspora Palestinians always told me their Palestine was beautiful. I always dismissed this as mere sentimentality. But on this farm house, I know it is.  

Although their home was spared total destruction, every single window pane was shattered. Many neighbouring buildings were also destroyed. Aida had tried to seal off the home from the cold, wintry Gaza air by pieces of polythene. When the cold wind blows, the polythene ‘curtains’ flap and send a chill across the house. The family’s warmth and generosity also concealed the dark history of Khan Younis. One evening, Aida’s mother told me of the massacre of Khan Younis in 1956 under the command of Ariel Sharon. Nearly all men were killed, resulting in the women and children having to dig their graves.  

How can I repay such hospitality of this Palestinian family? Each morning, before we embarked upon our visit to the hospitals, there would be Arabic coffee, home baked pastries, cheese and bread waiting for us. When we returned, there would be a cooked dinner. Just days ago they were eating bread with salt while Gaza was pounded by bombs. One day, we found that they had killed one of their turkeys and two chickens for us. As if it were not enough, Daim would leave one morning to buy us fresh fish. He could not allow us to leave Gaza without tasting their famous fish. It was extremely delicious, but I remember Gaza’s fishermen were often shot at or even killed by Israeli gunboats if they strayed outside the three-mile waters of their own coast. My eyes still brim with tears as I recall that fish dinner.  

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We managed to visit all hospitals and saw the extent of damages to schools, clinics and UN buildings. We introduced ourselves as the ‘British’ medical team. We spoke to the medical personnel and administrators whom we found to be extremely disciplined and dedicated. Like the parting of the Red Sea some thousands of years ago, we left in time before the barriers were lowered and Gaza was once again sealed off from the world. 

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In Gaza, we wrote a quick report of our findings. We wrote it on a morning when Israeli bombs fell hard and fast in southern Gaza. We put the facts down and sent it out immediately. It was our witness and was published in the medical journal, the Lancet Global Health Network. It attracted a great deal of attention. Excerpts read:  

The wounds of Gaza  

The wounds of Gaza are deep and multi-layered. Are we talking about the Khan Younis massacre of 5,000 in 1956, or the execution of the 35,000 prisoners of war by Israel in 1967? Yet more wounds of the first Intifada, when civil disobedience by an occupied people against the occupiers resulted in massive wounded and hundreds dead? We also cannot discount the 5,420 wounded in southern Gaza alone since 2000. Hence what we are referring to below are only that of the invasion as of 27 December 2008.  

Over the period of 27 December 2008 to the ceasefire of 18 January 2009, it was estimated a million and a half tons of explosives were dropped on Gaza Strip. Gaza is 25 miles by 5 miles and home to 1.5 million people. Prior to this, Gaza has been completely blockaded and starved for 50 days. In fact, since the Palestinian election, Gaza has been under total or partial blockade for several years...  

On the first day of the invasion, 250 people were killed. Every single police station in Gaza was bombed killing large numbers of police officers. Having wiped out the police force, attention was turned to non-government targets. Gaza was bombed from the air by F16 and Apache helicopters, shelled from the sea by Israeli gunboats, and from the land by tank artillery. Many schools were reduced to rubble, including the American School of Gaza, 40 mosques, hospitals, UN buildings, and of course, 21,000 homes, 4,000 of which were demolished completely. It is estimated that 100,000 people were made homeless.  

A. Israeli weapons – In addition to conventional weapons and high explosives, four categories of unconventional weapons could be identified – 

i. Phosphorus shells and bombs – eyewitnesses speak of bombs exploding at high altitude scattering a large canopy of phosphorus bomb lets which cover a large area.  

During the land invasion, eyewitnesses describe the tanks shelling into homes first with a conventional shell. Once the walls are destroyed, a second shell, a phosphorus shell, is then shot into the homes. Used in this manner the phosphorus explodes and burns the families and the homes. Many charred bodies were found among burning phosphorus particles.  

One area of concern is the phosphorus seems to be in a special stabilising agent, resulting in the phosphorus not completely burning out. Residue still covers the fields, playgrounds and compounds. They ignite when picked up by curious kids, or produce fumes when farmers return to water their fields. One returning family returning to water their field met with clouds of fumes producing epitasis. This makes the phosphorus an anti-personnel weapon against children.  

Surgeons from hospitals are also reporting cases where after primary laparotomy for relatively small wounds with minimal contamination, they find on second look laparotomy increasing areas of tissue necrosis at about 3 days. Patients then become gravely ill and by about 10 days those patients needing a third relook encounter massive liver necrosis. This may or may not be accompanied by generalised bleeding, kidney failure and heart failure and death. Although acidosis, liver necrosis and sudden cardiac arrest due to hypocalcaemia are known to be complications of white phosphorus it is not possible to attribute these complications as being due to phosphorus alone.  

There is real urgency to analyse and identify the real nature of this modified phosphorus as to its long term effect on the people of Gaza. There is also urgency in collecting and disposing of the phosphorus residues littering the entire Gaza Strip. As they give off toxic fumes when coming into contact with water, once the rain falls the whole area would be polluted with acid phosphorus fumes. Children should be warned not to handle and play with these phosphorus residues.  

ii. Heavy Bombs – the use of DIME (dense inert material explosives) was evident though it is unsure whether depleted uranium was used in the south. In the civilian areas, surviving patients were found to have limbs truncated by DIME, since the stumps apart from being characteristically cut off in guillotine fashion also fail to bleed. Bomb casing and shrapnel are extremely heavy.  

iii. Fuel air explosives – Bunker busters and implosions bombs have been used. There are buildings especially the eight-storey Science and Technology Building of the Islamic University of Gaza which had been reduced to rubble no higher than 5-6 feet high.  

iv. Silent Bombs – People in Gaza described a silent bomb which is extremely destructive. The bomb arrives as a silent projectile at most with a whistling sound and creates a large area where all objects and living things are vaporised with minimal trace. We are unable to fit this into conventional weapons but the possibility of new particle weapons being tested should be suspected.  

B. Executions – Survivors describe Israeli tanks arriving in front of homes demanding residents to come out. Children, old people and women would come forward, and as they were lined up they were fired upon and killed. Families have lost tens of their members through such executions. The deliberate targeting of unarmed children and women is well documented by human rights groups in the Gaza Strip over the past month.  

C. Targeting of ambulances – 13 ambulances have been fired upon killing drivers and first aid personnel in the process of rescue and evacuation of the wounded.  

D. Cluster Bombs – Dropped on the Rafah border crossing with Egypt. The first patients wounded by cluster bombs were brought into the Abu Yusef Najjar Hospital after the ceasefire. Since more than half the tunnels in the border with Egypt have been destroyed, Gaza has lost part of her life-line. These tunnels contrary to popular belief are not for weapons, though light weapons could have been smuggled through them. They are the mainstay of food and fuel for Gaza. Palestinians are beginning to tunnel again. However it became clear that cluster bombs were dropped on to the Rafah border and the first was accidentally set off by tunnelling. Five burn patients were brought in after setting off a booby trap kind of device.  

E. Death toll – as of 25 January, 2009, it is estimated 1,350 were killed with the numbers increasing daily. This is due to the severely wounded continuing to die in hospitals. About 40 per cent killed were children.  

F. Severe Injuries – The severely injured numbered 5,450 with 40 per cent children. These are mainly large burns and poly-trauma patients. Single limb fractures and walking wounded are not included in these figures.  

Through our conversations with doctors and nurses the word holocaust and catastrophe were repeatedly used. The medical staff bear the psychological trauma of the past month living through the situation and dealing with mass casualties which swamped their department and operation rooms. Many patients died in the Accident and Emergency Department while awaiting treatment. In a district hospital, the orthopaedic surgeon carried out 13 external fixations in less than a day.  

It is estimated that of the severely injured, 1,600 will suffer permanent disabilities. These include amputations, spinal cord injuries, head injuries, large burns with crippling contractures. There are 400 amputees of which 88 are bilateral.  

Special factors to consider – the high death and injury toll is due to several factors.  

No escape – Gaza is sealed off by Israeli troops. No one can escape the bombardment and the land invasion. There is simply no escape. Even within the strip itself, movement from north to south is impossible as tanks have cut off both halves. By contrast, it was possible for people in the Lebanon in 1982 and 2006 to escape from an area of heavy bombardment to an area of relative calm. Gaza does not have this option.  

Gaza is densely populated – The bombs used by Israel have been precision bombs, they have a hundred percent hit rate on buildings which are crowded with people, such as the central market, police stations, schools, the UN compound used as a shelter from bombardment, mosques (40 of them destroyed) and the homes of families who thought they were safe as there were no combatants in them. In high rise flats, a single implosion bomb would destroy multiple families. The pattern of consistent targeting of civilians make one suspect that the military are but collateral damage, while civilians are the primary targets.  

Quantity and quality of the ammunition – as described above.  

Gaza’s lack of defence – against the modern weapons of Israel. Gaza has no tanks, no planes, no anti-aircraft missiles against an invading army. We experienced that first hand in a minor clash of Israeli tank shells versus Palestinian’s AK-47 return fire. The forces were simply unmatched.  

Absence of well constructed bomb shelters for civilians – Unfortunately even if these were present they would be no match for bunker busters possessed by the Israeli army.  

Conclusion  

The next assault on Gaza would be just as disastrous. The people of Gaza are extremely vulnerable and defenceless in the event of another attack. If the international community is serious about preventing such a large scale of deaths and injuries in the future, it will have to develop some sort of defence force for Gaza. Otherwise many more vulnerable civilians will continue to die. 

The report stayed on the Lancet Global Health Network for 28 days – from 2 February to 2 March 2009. It was taken off the website due to massive pro-Israeli protest accusing it of factual inaccuracies. However, in those 28 days, it had found its way into many other publications and as of March 2009, has been translated into ten languages.  

Dr Ang Swee Chai  

March 2009 

   

Introduction  

My parents first met in a Japanese internment camp during the Second World War. My mother was only 19 years old when she was taken prisoner. She was a school teacher who gave up her work to become a community organiser for the ‘Oppose the Japanese Invasion’ campaign. My father was a young Chinese language editor of a paper which took a similar position.  

Mother acquired her strong views at an early age. Her father was extremely conservative and never believed women should have schooling, claiming it made them bad housewives. Indeed, he had three, none of whom could read or write. Mother would have none of this and at the early age of seven, decided to register herself with the headmaster of the neighbourhood school. It was a fait accompli by the time grandfather discovered this and he was flabbergasted.  

When grandfather reached the age of 60, he decided to take a fourth wife. Mother was furious and was even more livid when her own mother supported the decision. She decided to have none of this and packed her bags and left home. Grandfather, who always held a soft spot for his independent young daughter, could not dissuade her. His flood of tears and pleadings went unheeded.  

But being a woman in a man’s world had some advantages, though for the wrong reasons. When the Japanese invaded, informers said mother was an important member of the resistance. She was taken in, badly tortured and never confessed. Her life was spared because the Japanese interrogators could not believe a woman could have held such a key role.  

When her children were grown-up, mother would tell us. 

‘It’s not as bad as it sounds. The first time, you’re seared you’ll give away your friends. But there comes a point when you pass out. Once that happens, you cannot feel pain anymore. Once you have learnt that, you can beat your torturers.  

After her torture sessions, mother was locked up in the Outram Road prison in Singapore. Conditions there were atrocious and many prisoners died from torture, starvation and disease. There appeared not to have been segregation, and at Outram, she met Ang Peng Liat, my father.  

Father had also run away from home. But unlike mother, he was a first generation Chinese and fled southern China to escape an arranged marriage with a girl he had never met. His father ran his home with iron discipline and would not accept 

‘no’ for an answer.  

Father found his feet quickly and, by the time he was 20, edited a Chinese daily paper. War broke out and he mobilised his paper and public opinion against the invasion. His paper was soon shut down and he found himself in Outram Road prison.  

When peace finally came following Japan’s surrender, the prison gates were opened. People flooded in to meet the internees and greeted them with flowers. My parents, four years older, settled down to have a family.  

The immediate postwar years in Singapore and the rest of what was then Malaya, were marked by economic depression, poverty, hunger and sickness for all except the wealthy. My two elder brothers died in their infancy from malnutrition and infectious diseases. Four decades later, mother still weeps when she thinks of them.  

Fortunately, mother soon found herself pregnant again. This time, she returned to her hometown of Penang Island, to have her baby. It was a long and difficult labour. When the midwife held out an eight-and-a half pound girl to an exhausted young woman, everyone was relieved. A baby girl was of less value than a boy in traditional Chinese families, but a tough little granddaughter was still definitely better than no grandchild at all. So grandfather immediately offered me as a godchild to the Chinese Goddess of Mercy, Kuan Yin, and asked her blessing and protection to ensure I would escape the fate of my two elder brothers.  

My early childhood was spent in my grandfather’s house at Penang’s district of Ayer Itam. Mother wanted me to be nursed in his spacious rural house surrounded by lush tropical plants. Mother’s mother was then the only wife of his left alive and she felt Penang’s natural beauty was probably the best place to escape the effects of the trauma of the war’s aftermath.  

Grandfather had sobered in his old age and greeted the arrival of my brother Lee Cyn, a year later, with equal delight. Boys may have been more valuable than girls for others, but his granddaughter was different. So Lee Cyn and I were treated equally and had a very happy childhood in Penang, surrounded by trees and flowers, grown-ups doting on us, doves, a black- and-white dog and a large ginger cat.  

I can still remember the large ginger cat. It had a very large head and plenty of affection. I seem to be surrounded by cats and even in our current little flat in London, we have a 12- year-old ‘ang moh’ tabby with a very Chinese name, ‘Meowee’. But that ginger cat was the only one I have ever met in my life who could sit patiently while I stole its dinner. 

My grandmother nearly fainted when she found me on all fours eating Ginger’s food and in his little wooden hut built for him by grandfather. There was just room for the two of us and Ginger just watched and purred.  

Father’s work soon took mother, Lee Cyn and Ito Singapore a few years later. We left Penang and our doting grandparents to move into a two-bedroom, first floor flat just off a busy trunk-road at Upper Serangoon. Cars and lorries stirred up dust and fumes day and night and we all got our loud voices trying to talk through the din.  

Father worked long and hard to feed his growing family. Mother made sure her little kids were subjected to a strict routine. We were given a timetable which covered our every waking moment, copies of which were posted by our bedside, in the sitting room and in the kitchen. Story hour meant that mother would read us novels and short stories by Guy de Maupassant, Oscar Wilde and Edmondo de Amicis. Soon we graduated to Tolstoy, Gogol and Turgenev. She read them to us in Chinese and I never realised until much later that the writers wrote them in different European languages. Comics were absolutely forbidden and so were Enid Blyton adventures and pop music.  

During playtime, Lee Cyn and I found ourselves making paper boats and wishing all the time we could sail away in them to visit our grandparents in Penang. But our strict upbringing paid off in schooling terms and enabled us to top school examinations collecting prizes and medals.  

Swee Kim and Swee Hua, my sisters, soon arrived and both Lee Cyn and I had to stop making our paper boats. Suddenly I became ‘Big Sis’ and he, ‘Second Brother’. The two younger sisters made us a real family and the flat a real home.  

Lee Cyn and I soon went to a primary school nearby. Going to the Kwong Avenue Primary School and coming back was a pleasant walk each day. After mother’s rigorous timetable, school became fun and easy-going. Those school years were great years. I made friends, read new books, acted in school concerts and plays and, of course, received prizes each year.  

I can still remember many of my primary school classmates. Hatifah was the fastest sprinter. She caught up with me recently when I received a letter from her in February 1989, following the launch of my British edition of this book. She currently lives in West Germany and had read an article I wrote which appeared in the German weekly magazine Der Spiegel, about my work for the Palestinians in the occupied territories of Gaza. She reminded me how thrilled I was when Sputnik went into orbit in 1957 and how I vowed to be a scientist one day when Yuri Gargarin became the first cosmonaut a few years later.  

In primary school, I saw the world an exciting place and science as my passion. But I was also aware many important things were happening in the then Malaya and Singapore. The British were ending their rule in Singapore and I remember how we elected our very own government in 1959 for the first time. As a 10-year-old, party politics made very little sense, but the thought that Singaporeans were having their own rule and their own national anthem was simply grand. Everyone was a Singaporean or a Malaysian, whether their ancestors came from India, China or Indonesia.  

After the entrance examination I found myself at Raffles Girls’ School. Life was less idyllic and I was soon put in my place. My classmates were all extremely bright and for the very first time, I found I had to study hard to keep myself among the top in class. So I had to allow no time for socials, parties and dating. Music and reading were my passions but I also foolishly fell in love with the game of chess. Chess was extremely time-consuming – what with tournaments and practising. I found I had to cut down on my music lessons and reading if I wanted to be good at the game. 

At secondary school, my interest in science grew. But it took a new turn. I still found the world fascinating and the various scientific disciplines stimulating. Soon I realised science was not neutral and had a role to serve the needs of society. I cannot remember how this came about but it must have come from the career guidance programme given by the Ministry of Education. We were told at school that ‘science, to be meaningful, must be channelled to alleviating suffering and poverty. I took that message seriously and began to ask how science could help and soon found myself asking questions about poverty itself, about hunger, bad housing, disease and illiteracy. Some of my close friends soon began to worry about my very eccentric ‘philosophical’ questions.  After my ‘O’ and ‘A’ Levels, I chose to study medicine at the University of Singapore. I thought medical science could do a great deal. Lee Cyn followed in my footsteps and father had to work day and night to pay our tuition fees.  I proceeded to do a masters’ degree in public health and community health medicine and then an FRCS (England) to become an orthopaedic surgeon. Academic degrees and gold medals merely gave me the chance to apply medical technology. Surgery also combined my three passions: medicine, kitchen work (using knives and cutting up meat) and sewing. These were skills women were equally adept at as their male colleagues.  

At medical school, I was also converted into Christianity. My parents, having gone through much suffering and seen much death, chose to remain ‘areligious’ but always insisted their children had the right to choose their own faiths.  

My Christianity made me ask more questions about my role as a doctor. The skills we possess and the knowledge we hold, allow us to make plenty of money. They also gave us prestige. But doctors live in society and must serve its members.  

On 29 January 1977, I married Francis Khoo, a Catholic lawyer, who was also asking many questions about his role in society. As a Baba of many generations in Singapore and more comfortable in Malay than in Mandarin, he was fiercely proud about his country and region. He told me, and still does, that we must never adopt the footloose mentality of the migrant. ‘We must set roots wherever we are, otherwise there would be no Singapore and no Malaysia. Otherwise we become neither here nor there; we should he both here and there.’  

Ang Swee Chai  February,1989 

   

 

PART I 

Journey To Beirut 

 Summer 1982 

   

Chapter 1  

The summer of 1982 was our sixth summer in Britain. My husband, Francis, had left our home country of Singapore, and I joined him in London. It took us some time to get settled, but by 1982 we were living in a small flat in the city centre.  

Night after night, the television news bulletins featured the Israeli invasion of Lebanon. What was particularly horrifying was the way Beirut was being attacked from the air. Francis and I sat and watched Israeli planes dropping bombs on to blocks of flats: they were bombing densely populated, civilian areas in the capital of Lebanon. News programmes showed pictures of high-rise blocks along the Beirut sea-front: they reminded us uncannily of our old flat in Marine Vista, back home in Singapore. There were horrible scenes of wounded and dead people, many of whom were children. Then came the news of the Israeli blockade of Beirut. Medical aid was denied to the wounded; the city was denied water, electricity and food.  

Lebanon and Beirut were unfamiliar names to me, but Israel was not: my church had taught me that the children of Israel were the chosen people of God. Many of my Christian friends held that the gathering of the Jews from all over the world into the State of Israel was the fulfilment of scriptural prophecies. 

Israel had my support for other reasons. In London, I had spent hours watching television programmes which showed how appallingly the Jewish people had suffered under the Nazis. Both of my parents had suffered at the hands of the 

Nazis’ allies, the Japanese Imperial Army. As a refugee in a foreign country, I understood what it meant to be stateless. The creation of the State of Israel, giving all Jews a home free from persecution, seemed to me to be an act of justice – even one of divine justice.  

The newspapers said that the Israeli invasion of Lebanon had made a hundred thousand people homeless and had killed fourteen thousand people, and this upset me terribly. I could not understand why Israel had done this. There had to be a good reason for it.  

Most of the news stories in Britain depicted the invasion as an attempt by Israel to flush out the Palestine Liberation Organisation – or PLO – from its bases in Lebanon. All I knew about the PLO was that it was an Arab group which hijacked passenger jets, planted bombs and hated Jews.  

Some of my Christian elders told me that the Palestinians were the descendants of the Philistines of the Old Testament, and everyone knew that the giant Goliath was a conquering Philistine who terrorised his opponents. The tale of David and Goliath had been one of my favourites when I was a Sunday School teacher: I loved telling my kids how little David brought down the mighty Goliath. (I am a couple of inches under five foot tall myself.)  

From the news coverage, however, it looked as though Israel had turned into Goliath: a swaggering giant bringing destruction, terror and death to neighbouring Lebanon. An Israeli leader told the press that much as he regretted the casualties, to make an omelette one first had to crack eggs.  

Crack eggs? That remark shocked me. What kind of ‘omelette’ was Israel trying to make, and were the people in Lebanon eggs to be cracked? It was clear from the news reports that nearly all of the people who had been killed, wounded or made homeless were civilians, many of them women and children. Bombing civilians is a disgraceful way to make war. The bombs fell for days: on playgrounds, cemeteries, houses, hospitals, schools and factories. Even international Red Cross ships bringing food and medical supplies to Beirut were targets.  

From what I heard, I concluded that nobody cared, and that God had turned away from Lebanon. Seeing the wounds of the people in Lebanon hurt me, firstly because they had been inflicted by Israel, secondly because I am a Christian and thirdly because I am a doctor. I could not understand how Israeli planes could drop phosphorus bombs on to civilians in such a crowded city. I asked God for an explanation, asked Him to grant me understanding.  

Then one day in August 1982 I heard from a colleague – Bryan Mayou – that an international S.O.S. had been sent out for an orthopaedic surgeon to treat war victims in Beirut. God had answered my prayers: as an orthopaedic surgeon, I knew what I had to do. For the first time that summer since the war had broken out, I felt at peace. 

 

   

Chapter 2  

When I had been unsure about what to do with my life, my brother had nudged me towards medicine. When I had been shocked by the gruesome reality of medical school, my parents had persuaded me to stick to it. When community medicine had got me into hot water for being too outspoken for Singapore, orthopaedic surgery had provided me with a bolthole. When Francis and I had to leave Singapore, I wanted to work as a surgeon in Britain, but found plenty of white male prejudice in the British medical establishment. I got my way, and became a Fellow of the Royal College of Surgeons. Now I was officially an orthopaedic surgeon, it was time to put my skills to good use.  

When I first applied to go to Beirut, the Christian charity in Britain which organised the volunteers did not want to send me, because I did not have a passport. All I had was a ‘British Travel Document’. The charity was afraid that I would not be able to enter Lebanon without a passport. Francis spoke to the British Foreign Office, and they assured us that although my travel document would not normally entitle me to the protection of British diplomatic or consular representatives abroad, they would be as helpful as possible if I ran into trouble and needed help from the British Ambassador in Beirut. Armed with this verbal assurance, I managed to persuade the Christian charity to take me on. Francis next spoke to Colonel Gray of the British Red Cross to make sure that I was experienced enough for the job. Colonel Gray was delighted by the news, and wished Francis the best of luck in his venture. It was a while before he realised that it was not Francis who was planning to go to Beirut.  

It did not take long to get ready to travel. I resigned from my hospital in Britain, packed my bags and set off for the airport. Because the Israelis had closed down Beirut International Airport, we had to fly to Larnaca in Cyprus and then take a ferryboat from there. A number of us flew out at the same time – I was by no means the only doctor to volunteer to go to Beirut. Altogether, there were about a hundred medics from all over the world. We had different colours of skin and practised various religions – Christianity, Islam, Judaism and others. We had all left our homes in the hope of being able to help the wounded people of Lebanon. In the ensuing months, some of us were to become very close friends.  

August was peak holiday time, and the jet took off from London’s Heathrow Airport packed with carefree tourists bound for sunny Cyprus and its beaches. After a few hours sharing the plane with these rather strange fellow-travellers, I stepped out of the plane at Larnaca Airport.  

In some ways Cyprus reminded me of South East Asia, and I soon found myself thinking of home. When I decided to become a doctor back in Singapore, this caused a difference of opinion between my parents. My mother was thrilled to bits at the thought of her daughter becoming a doctor, but my father was in favour of a musical career. I got my way, and resolutely set off for my first day at medical school.  

What nobody told me was that I would be spending my first day there dissecting human cadavers preserved in formalin. The anatomy dissection room looked like the set of a horror movie, and the smell of formalin was so pungent I nearly suffocated: it went up my nose, burning the lining, and made my eyes water.  

There were twenty-two women in our year, and ninety- eight men: we were put into groups of six, and each group was allotted one dead body to dissect. The poor cadaver was going to be cut up bit by bit over the academic year. Pieces of mutilated limbs and sliced-up lungs, brains and hearts, which had been left by our predecessors, were lying about on dissection tables, in basins and even on the floor.  

On dissecting table number one was my group’s cadaver. I had a look at it. The label said, ‘Male, unknown identity, unclaimed.’ Then the Professor of Anatomy came in: he was loud and lively, and wielded a human thighbone, which he was using as a pointer.  

‘Hello, small miss!’ said the professor. With a grin on his face, he lightly tapped me on the top of my head with the thighbone. Startled, I nearly let out a scream, for I had never been touched by a bit of a dead human being before. Fortunately for me, there was a loud bang and the whole class turned round to look. Two of the male students had collapsed on to the floor. That saved the day, and the class was adjourned while my two classmates were lugged outside to the field for some fresh air and a drink of water.  

What with all the commotion, I got away. When I reached home, I told my mother that I was through with medicine. However much I wanted to devote my life to the relief of disease and suffering, my disposition was too delicate for me to confront death and decay every day.  

My poor mother was terribly upset to hear this. She reminded me of the progress made by women in the twentieth century: only fifty years earlier, Chinese villagers had drowned baby girls quite regularly in rivers. ‘You have so much to give others if only you seize the opportunity,’ she said. ‘Here you are wanting to throw it all away just because you refuse to overcome your fear of dead bodies! Since when have I brought you up to be such a weakling? You disappoint me! Mother could not go on: she was crying.  

In that moment, I realised how hard things had been for her. She had given up her career as a teacher and writer twice. The first time was to organise resistance against the Japanese military occupation, and she ended up in an internment camp as a result; the second time was to bring us up. She had sacrificed a great deal for us children, and she had given us a lot as well. Where my schooling had taught me to read and write, my mother had educated me. Through her, I learnt about the poverty and suffering of ordinary people and the degradation and abuse of women. From her, I received a vision of life as it ought to be. I owed her a lot. But she did not manage to change my mind about giving up medicine.  

Father took it differently. When he was told that I would not have anything further to do with medical school, he contented himself with calmly informing me that I had broken my agreement with him, and asking me if I would like to consider giving him back the year’s fees which he had just paid. I was back in that awful dissection room the next day.  

After a few weeks I really liked the Professor of Anatomy, and soon I was so at home in the dissection room that I would be eating sandwiches and drinking coffee while at the same time examining bits of the cadaver.  

As a houseman’ or ‘intern’, I soon realised there was nothing special about being a doctor. Medicine is just the application of technology so as to mitigate disease and pain. A doctor is a technician trained to deal with certain problems. Noble thoughts about saving lives soon go out the window: 

we apply know-how’ and ‘training’ to medical emergencies and difficult diseases, and try to find solutions. Other people fix broken-down cars, or unblock sinks. They are technicians too.  

I thoroughly enjoyed both my medical studies and working in the Singapore General Hospital. I was fully occupied throughout my waking hours. Life revolved around the wards, the out-patient clinics, clinical conferences, operating theatres and the library. My social circle consisted of colleagues and patients, and occasionally members of my family. The hospital became my place of work and play, of joy and sorrow, of success and failure – it was where I lived, and it became my whole world. That is how any young doctor working a hundred-hour week manages to stay alive.  On those rare days when I was free and not ‘on call’, I ventured out of the innards of the hospital. Sunlight, clouds, open air, then the pavement beneath my feet: they all felt unreal at first. Large shopping centres with brilliantlycoloured window displays in department stores, ladies with fashionable clothes and classy make-up, busy traffic and crowded buses, flashing lights, pop music blaring out of shops: it was a strange world to step into.  

Singapore is an extremely hectic city – urban, modern, commercialised, industrialised and often electronic. People are always in a great hurry. Delicious meals are gulped down in eating places. That might be the right way to treat hospital food, but out in the city where our local food is so varied and rich, not to spend a moment or two savouring it is a crime.  

To stop the place becoming a concrete jungle, the Government has embarked on an extensive tree-planting campaign to turn Singapore into a ‘garden city’, as the tourist promotion board puts it. There are large parks and gardens, which make the whole place very pleasant.  

For the first time in ages, I became violently homesick for Singapore. In Cyprus I was walking about in the heat of the sun, and the red hibiscus made me think of South East Asia and home.  

Because we arrived during a thirty-six hour air raid on Beirut, we had to spend a few days in Cyprus. A United Nations official on the island told us that twenty thousand families in Lebanon had lost their homes because of Israel’s invasion, but that an accurate count of the dead was impossible, partly because many of the bodies were buried under rubble and partly because many people had been taken away by the Israelis and there was no way of telling if they were dead or alive.  

While we were waiting in Cyprus, news came that the Israelis had bombed yet another International Red Cross ship. Being a doctor seemed to confer no immunity where these Israelis were concerned. If they could do that to the 

International Red Cross, which was protected by the Geneva Convention, what would they do to me, a volunteer doctor protected only by a refugee’s travel document? What would they do to the other volunteers? I thought to myself, well, all right, at least if I happen to be blown up the people in Lebanon will have had one Singapore friend who did try.  

Then I thought about Francis. Leaving Singapore had cost him his career as a lawyer, his home, his family and his friends. All he had left was me – his wife – and yet lie supported my decision to go to Lebanon. Back in London, he had said to me, ‘Look, Swee Chai, if I were a doctor, I’d have gone myself. But I’m not a doctor, so the least I can do is support you in going.’ And he put on a brave front and helped me pack my bags. He probably did not think I realised that his whole being was crumbling inside him at the prospect of having to receive my dead body if the Israelis saw fit to drop a bomb on my hospital. The night before I left, I made him take a sleeping pill and asked him to resign himself to the fact that I might come home in a big, black, plastic bag.  

As I was stepping out of a lift, a voice interrupted my thoughts: ‘Doctor, are you going to Lebanon to help my people? Thank you very much, and welcome.’  

Wearing white trousers with a tan belt, and a pale cotton shirt, the speaker was tall, dark-skinned and middle-aged.  

‘Are you Lebanese, then?’ I asked.  

‘No, I am Palestinian,’ he said. 

This was the first Palestinian I had met. The word ‘Palestinian’ had an unpleasant ring to it, despite this man’s perfect English and very polite manners. I really did not like the idea of talking to a Palestinian. ‘You mean you are PLO?’ I asked, furtively looking to see if he was hiding a gun or a grenade somewhere on his body.  

The man explained that he was not a member of the PLO but a university lecturer. His subject was Arabic Literature. Loudly breathing a sigh of relief, I agreed to have lunch with him. He then started to tell me about himself, and I was quite bewildered by what he had to say.  

My new acquaintance’s family came from a town called Jaffa. ‘You will have heard of the famous Jaffa oranges,’ he said. ‘The Israelis say that they made the desert bloom, but I was born in an orange grove: my ancestors had grown oranges for centuries. They drove us out. We lost our home and our oranges, and we became refugees. My family was split up. My mother and my sisters fled to Jordan. One of my brothers is now in Saudi Arabia, another is in Yemen, and the last one is in Kuwait. My father stayed in the West Bank, and kept me with him. Unfortunately, the West Bank became harder and harder to live in, and when I was thirteen I ran away from home because I couldn’t stand it any more. I reached Beirut and got into the university there. So my family is all scattered now. I just wish that one day I could see all of them again.’  

This was the first time I had heard such a story. ‘What do you think of the PLO?’ I asked.  

He had a very straightforward relationship with the PLO: he gave it five percent of his income and saw it as his government. No one had ever described the PLO to me as a government before. I must have looked surprised, because he asked for some paper. When I gave him a large piece of white paper, he started drawing a diagram of the PLO’s organisation: there was the National Council, his parliament; the Trade Union Federation, his Ministry of Labour; the General Union of Palestinian Women; the Palestine Red Crescent Society, his Ministry of Health; and so on. The paper filled up with more and more organisations. Suddenly he stopped writing, and said, ‘You know, we’re always called “terrorists”. There are five million of us. If we were all terrorists, we would have destroyed the whole world in one day!’  

It did not convince me a hundred percent. Looking at his sheet of paper, now completely filled up with boxes, lines and words, I had to admit that the diagram did look like the sort of structure you might expect of a government representing five million people. But it did not square up with my image of the PLO. Was this a band of Arab terrorists or what? Were these hijackers, bombers, Jew-haters?  The other thing that did not square up was ‘Palestine’. Incredible though it may seem, I just had no idea where this 

‘Palestine’ was. From my handbag, I took out a map of the Middle East. There was no ‘Palestine’ on it. When I asked him to show me where his Palestine was, he put his finger on Israel, and said that that was ‘occupied Palestine’.  

‘The occupiers drove nearly one million Palestinians out of my country in 1948,’ he said. ‘Not only did they take over all the land and property of those who were driven out, but they changed the name of my country to Israel. Those of my people who refused to leave were badly persecuted, and still are, even today.’  

After a two-hour discussion over lunch, I finally realised – for the first time in my life – that the Palestinians were exiles. What my Palestinian acquaintance was telling me was that the PLO was their government in exile. Although I wanted to ask him about how the PLO was connected to the Israeli invasion of Lebanon, I was late for a briefing session for the medical volunteers, and had to hurry off. As I was leaving, he came after me, and said very seriously, ‘Doctor, you must see Palestine. If you get there, please see if my father’s house is still there, and send me a picture if it is.’ He told me where his father’s house was, and gave me his own address. 

The briefing session was not very useful, at least as far as I was concerned, because I did not really concentrate on it. My mind kept wandering off, thinking of the things I had just heard about the Palestinians. If what I had been told was true, I could not understand why I had never heard this about the Palestinians before. If I had not volunteered to go to Lebanon, I might never have found out about them. But on the other hand, the man might have been a PLO agent feeding me misinformation. Why should I believe his story at all? If the PLO were not terrorists, why did everybody say they were? I had no way of knowing what the truth of the matter was, but it seemed likely that I would discover it in Lebanon soon enough.  

The next day, we boarded a boat for Beirut. The voyage was uneventful – apart from being stopped once by an Israeli gunboat. The boat itself was a typical Mediterranean ferryboat, with people sitting around on the decks, and gambling at the casino inside. But there was a strange air of uneasiness. No one wanted to talk about the war, but each time a moving object was spotted on the horizon, everyone murmured, ‘Israelis’. The restaurant was closed for the day, but drinks were available.  

Most of my colleagues sat on the top deck, on long wooden benches, and stared long and hard at the sea. We had been warned not to talk too freely to strangers, no matter how friendly they seemed. A young man came up to me, and asked if our party was going to look after war victims. I answered, ‘Yes’. He then started expressing his admiration for medical workers who volunteered their services to others who were suffering, but told me in no uncertain terms that the Palestinians and Muslim Lebanese in West Beirut were troublemakers and deserved no help. His comments led me to believe that he must either be Israeli or an Israeli sympathiser, and I quickly excused myself from his company to avoid being dragged into further controversies. 

   

Chapter 3  

The boat pulled into Jounieh, the harbour to East Beirut, at dusk. I could see how this small harbour might have been an idyllic holiday resort, were it not for the presence of so many uniformed soldiers with machine guns. Brightly-dressed women with typical Mediterranean features, wearing fancy hats, helped me to forget for a moment that I had come into a country at war. Beyond the heavy military presence were rich green mountains and a clear blue sky, and in the foreground was the sparkling Mediterranean Sea, with numerous sailing boats, even then.  

We were met by the Lebanese organisation which was going to look after us and act as our employers, and they put us up in the first floor of a hospital in East Beirut. The city was divided by the ‘Green Line of Peace’ into a Christian East and a Muslim West: why it was called the Green Line of Peace I do not know, because over the years more battles were fought across the Green Line than anywhere else. Possibly it was from an old ceasefire between the Christians and the Muslims. If so, the ceasefire had clearly broken down. Several roads linked East and West Beirut, and those roads formed the ‘crossings’. The Christian end of a crossing was usually guarded by Christian soldiers, and the Muslim end by Muslim soldiers, both of which were usually part of the official Lebanese Army, which was divided into brigades along religious lines. Thus the Sixth Brigade was composed mainly of Shi’ite Muslims, the Eighteenth Brigade was Sunni Muslim and the Fifth Brigade was Christian.  

As well as the official Lebanese army, there were many non-official militias, both Christian and Muslim, each connected with a political or religious group, and there were also the private militias of the prominent and wealthy.  

Next morning we found that the Green Line crossing we planned to use was closed, and so we had the day free to wander round East Beirut. As a total stranger, I was warned that until I knew the local groupings and their allegiances I had better use my eyes and my ears and keep quiet, especially in front of soldiers and militia members. Any slip of the tongue might endanger both me and my colleagues. For instance, expressing anti-Israeli sentiments could spark off a hostile reaction from certain Christian militias or sections of the Army, because at that time the Christians and the Israelis were allies.  

East Beirut was a large, busy city. There were shops, banks, cars, traffic lights, people going about their business. The Lebanese are good-looking people on the whole, with healthy tanned skin and typically Southern European features. The women are especially attractive, with the warmth and vivacity of daughters of sunny climes. The main reminder that there was a war on came from the many soldiers, military vehicles and tanks. The soldiers’ uniforms were very interesting: some wore dark green, some light green and some khaki. Certain soldiers had special insignia, while others had large coloured patches on their uniforms. I quickly learnt to recognise the colours and insignia of the Israeli soldiers, and was surprised when I saw groups of young Lebanese girls going up to them to present them with flowers.  

After a while, I found a large, crowded post office, where I paid a hundred Lebanese lira – £30 sterling – to make a three-minute call to London. I spoke to Francis, assured him that I was in good hands and told him that I would probably cross from East to West Beirut the next day if the crossing was open.  

Once I had made my phone call, I found a bookshop and bought a dictionary, an English-French one, because most of the Lebanese I had met spoke French. Then I got hold of some sweet, fragrant Lebanese pastry, found a place to sit on the stairs going into a large office, and started to devour both food and dictionary. The former was absolutely delicious, but trying to learn French gave me the most awful indigestion!  

After wandering around the city all day, I returned to the hospital, went to bed and fell asleep almost immediately.  

The next day we all rose early to cross the Green Line into West Beirut. We were driven along a dusty, winding road, punctuated every fifty or a hundred metres by sandbags and soldiers. These checkpoints were all controlled by different groups of militia members. Apart from the nuisance of being stopped at them to have our papers and luggage checked, we were not given a hard time. The nearer we got to West Beirut, the dustier the road became. Suddenly we were past the Green Line into West Beirut, which looked just like it did on television, except that now it was life-sized and threedimensional.  

By the time I arrived in West Beirut, the worst of the air raids were over. Although it was a relief that bombs and shells were not falling out of the sky, I was shocked at the destruction of the city. Bombed-out buildings, piles of rubble, collapsing walls, large potholes dug in the road by bombs and shells – the whole place looked an utter mess to the uninitiated, and was a ghastly nightmare for her inhabitants. Those pockets of Beirut which had escaped destruction were still very beautiful. In my mind’s eye, I could see what this city must have been like before the wars began. The ‘Pearl of the Middle East’, set against the mountains and washed by the waves of the Mediterranean, must have been a paradise planted with cedar trees, orange trees, roses and jasmine flowers, which were nourished by the rivers and blessed by the sun. 

  

The ruins of a West Beirut block of flats, destroyed by 

Israeli bombs in 1982 

 But most of the lovely buildings of polished stone and marble had been turned into hideous bombsites. War had tarnished this beautiful pearl, leaving deep, dark wounds which might never heal. Our Lebanese driver pointed out that not all the destroyed buildings had been blown up by Israeli bombs. Some had been destroyed as far back as the ‘First Civil War’ of the mid-1970s. Lebanon had not seen peace for years and years. Like most Lebanese, our driver was sick of wars.  

Some of the latest weapons had been tested on this city. The implosion bomb, also known as the vacuum bomb’, was capable of sucking’ a ten-storey block of flats to the ground in a matter of seconds – reducing it to a mighty heap of concrete and rubble, burying all its occupants alive. It was all over in an instant, unlike what happened with the phosphorus bombs: the phosphorus stuck to the skin, lungs and guts of the victims for ages, continuing to burn and smoulder, and causing prolonged agony. Phosphorus is a metal many people will remember from chemistry lessons at school: it is quiet under water, but take it out and it starts to burn spontaneously. Victims of phosphorus bombs who had taken phosphorus into their lungs were doomed – they exhaled phosphorus fumes to their last breath. Burns on the skin often penetrated deep into the muscles and bones.  

Then there were the anti-personnel bombs – the fragmentation or cluster bombs. These exploded and scattered small pieces over a large area. The pieces lay dormant till accidentally picked up, often by curious toddlers, and then they exploded into countless bits of shrapnel. People wounded by such shrapnel often suffered multiple injuries to the face, eyes, bones and viscera. Fragmentation bombs with delayed trigger mechanisms, dropped on densely populated areas, were clearly aimed at civilians, and especially children. As well as all these sophisticated and cruel inventions, there were of course conventional high explosive bombs and shells.  

So was this the ‘omelette’, then? Or was it just ‘cracking eggs’?  

The offices of my Lebanese employers were located in Hamra – the fashionable district of West Beirut which contained the American University Hospital, offices, hotels, posh apartments, banks and department stores, and which had escaped the worst of the bombing. The luxury hotels were packed with journalists: the Beirut war was a hot story for them, and hotel prices soared as a result. Steak and wine, salmon and champagne, music and guest artists – within hotels such as the Commodore these were freely available to those who could afford them. But while the hotels filled their swimming pools for the enjoyment of their guests, the rest of the city was queuing up at water points.  

Hamra contained two worlds: the highly-paid foreign correspondents in the large, sophisticated hotels and the refugees with no home to call their own. Most of the offices and flats had been deserted by their wealthy owners, who had fled to Switzerland, France or just up to the mountains behind East Beirut. Wealthy Lebanese often owned three or four homes in three or four different countries. The buildings they had left were now occupied by thousands of squatters from the southern suburbs of Beirut and from south Lebanon, where the bulk of the bombs and shells had landed, destroying their homes.  

Refugees were huddled in temporary shelters in empty buildings, garages and stairways. Relief centres for displaced and homeless families had been set up, where water, food and bedding were handed out by relief agencies and by the United Nations.  

The plight of these destitute people made our own problems look trivial. So what if there was no tissue paper, no Danish cheese, no running water, no electricity? All of us knew we had a home to go back to. We were only doing a few months or a year in Beirut, but there was no light at the end of the tunnel for the refugees.  

In fact, when I revisited Beirut nearly six years later, I found that many of the refugees were still living in the same temporary shelters – in garages and abandoned buildings, just as crowded and dimly-lit as before. I heard the same cries of hungry children and anxious mothers. But there was one difference. In 1982 I assumed that their problems would be sorted out once the invasion was over. In 1988 I knew that they were homeless Palestinians and Lebanese who would remain homeless for many years.  

In the evening, the foreign medical volunteers returned from a tiresome day-long briefing session to our temporary quarters, which were at the nurses’ hostel at the American University. This was within walking distance of the American University Hospital. The whole complex was pretty empty, since most of the students had fled from the war. Most of the hospital’s nurses had gone too, except for a lot of Filipino nurses.  

Naturally we got to talking with them. ‘It really is so good of you to stay behind to look after all these war casualties,’ I said. ‘Aren’t you afraid?’  

‘Of course we are,’ replied one of the Filipinos, ‘but our passports have been kept, so we couldn’t leave even if we wanted to!’  

This upset the three newly-arrived volunteer nurses from the USA: they thought it was wrong to keep the Filipinos’ passports.  

The American University Hospital had saved countless lives. It always had excellent standards and was comparable to any large British teaching hospital, with well-trained staff and the latest laboratory and technical facilities. The medical and surgical staff were good by international standards.  

Unfortunately the hospital was entirely private. At that time a patient had to put down a deposit of ten thousand Lebanese lira (about £3,000 sterling) before even being admitted to the hospital. People who did not have enough money were turned away. For someone like me, who had spent years working in Britain’s National Health Service, this kind of ‘cash on the nail’ medicine was almost impossible to accept – especially if we were going to be dealing with wounded people.  

Nearly all Lebanon’s hospitals were private. The American University Hospital, being the finest one, charged the highest rates, and less prestigious ones charged less. So you got what you paid for – there was a kind of sliding scale. Even that system had been disrupted by the Israeli invasion: most of the other hospitals had been destroyed. The Lebanese told me that any building flying the red cross had been a target for Israeli bombardment. The Makassad, Babir, Akka and Gaza hospitals were all attacked and put out of action. In the south, hospitals in Nabatieh and Saida were also hit. But they did not dare to attack the American University Hospital. 

So, although it was expensive, there was still a fine, functioning hospital left for the desperate people of Lebanon.  

But I had not come all the way to Beirut to work in a private hospital. I wanted to help those in need, and those who were most in need were poor, and could not pay for treatment. The next morning we arrived at the office of our Lebanese hosts, and there we were introduced to Dr Rio Spirugi. He was a wiry Italian Swiss, who had once worked for the International Red Cross, but had given it up to be the coordinator for the Palestine Red Crescent Society (PRCS). He had come up to the office looking for surgeons, anaesthetists and theatre nurses – in short, a surgical team – to work in Gaza Hospital, which was run by the Palestine Red Crescent Society. Dr Spirugi explained that Gaza Hospital offered free medical care to all those in need, and I was absolutely delighted to hear this. I remembered that the Palestinian man I had met in Cyprus had told me about the medical services of the Palestine Red Crescent Society. At that time, of course, the last thing in my mind was any idea that I might end up working with the PRCS.  

Six of us volunteered to work with Dr Spirugi. Mr Bryan Mayou, a brilliant consultant plastic surgeon from St Thomas’s Hospital in London, who had taught me nearly all my reconstructive surgery and microsurgery, would be the head of the team. Besides having been my teacher, Bryan was also a friend of mine. It was Bryan who had brought to my attention the appeal for volunteers to go to Lebanon. The others in the team were Dr David Gray, an anaesthetist from Liverpool, Dr Egon, an anaesthetist from Germany, two theatre nurses – Ruth, from Denmark, and Sheila – and myself. Dr Spirugi seemed reasonably happy with the little flock he had gathered. He packed us into his blue Peugeot estate car, on which was painted the insignia of the PRCS, and set off with us for Gaza Hospital.  

‘You know,’ he said to me, ‘I worked in South Vietnam as part of the International Red Cross during the US war. But unfortunately Thieu threw me out.’ He chuckled.  

I guessed that he took me for a Vietnamese, so I explained that I was a Singaporean.  

‘Most of you have probably worked in other countries outside Europe,’ he said as we drove along. ‘What you must understand is that the Red Crescent had no shortage of medical staff before the invasion. But during the first week of the invasion they arrested a hundred and fifty doctors and nurses. Many others are still missing, and those who worked throughout the war are finished – they’re too tired. Some of them are shell-shocked.’  

We passed a television crew. ‘Tourists,’ said Dr Spirugi. ‘These journalists are simply tourists. They treat the war as one big spectacle. Always on the look-out for couleur locale, they have no commitment to anything. And they don’t feel anything for the people here.’  

The journalists receded behind us. Dr Spirugi obviously did not like them, but I could not help wondering how the rest of the world would know anything about the Israeli invasion if it were not for these ‘tourists’.  

‘Guess what!’ said Dr Spirugi. ‘I had some trouble with that crazy lot in the offices this morning. When I asked if I could take some of you to work in Gaza, all they wanted to know was whether you would be able to join the rest of the volunteers for weekend trips up into the mountains. We’re in the middle of a bloody war, for God’s sake, and all they care about is holidays and excursions. It’s madness.’  

He laughed out loud. I did not see what was so mad about it. The war was not being fought everywhere: we had just come through East Beirut, where there was no war. Our Lebanese hosts obviously wanted us to see more of Lebanon than just piles of rubble in West Beirut. But we said to Dr Spirugi that we would be happy to forgo the weekend trips if we were needed at the hospital, and that cheered him up a lot.  

This was the first time I had been taken round West Beirut. Except for the odd vehicle, there was no traffic on the roads, and Dr Spirugi drove very fast. Luckily he was worried about overturning a large barrel of concentrated chlorine in the back of the car, or he would probably have driven even faster. ‘Mind the chlorine, it is for disinfecting the whole of West Beirut,’ he repeated a few times, as he went sharply round the bends.  

He chose a route to take us past the Babir and the Makassad hospitals, to show us the destruction visited upon two major Lebanese hospitals. ‘The evacuation of the PLO will start soon,’ he said, as we drove past Makassad Hospital, ‘and once that is over, we’ll move the casualties from the field hospitals back to Gaza and Akka hospitals.’  

Eventually we arrived at what Dr Spirugi said was Akka Hospital. What greeted our eyes was a huge pile of concrete waste – tons of rubble in what looked like a demolition site. There was no hospital left. Once he had parked the car, Dr Spirugi did not even give us time to take a second look: he marched us straight on into the rubble. We stumbled over torn-up cables and debris, and found a staircase going down beneath the partially collapsed walls.  

For a moment, I felt a little lost. The concrete steps were uneven, and it soon became so dark that I could not even see my own fingers. My eyes got used to the darkness, however, and Dr Egon found a torch from one of his eight pockets. We stumbled on down. Were we going into a dungeon? Then I realised that we were in the basement of Akka Hospital. The tons of rubble up above must have prevented the basement from being totally destroyed.  

Rio Spirugi started calling, presumably in Arabic – I knew it was not Chinese, French or Malay. Some people came out of a room to greet him. They were some of the staff of the Palestine Red Crescent Society. Five or six men and women, they all looked haggard and traumatised. I wondered if they were suffering from shell-shock. We were introduced, and then they showed us round.  

Normally I would have asked a lot of questions. I am not known for keeping quiet. But how could I ask the Red Crescent staff, who had obviously been through hell, what had happened to their hospital?  

It was at Akka Hospital that I learnt my first word in Arabic: ‘halas’ – ‘finished’. The school of nursing and the Arab centre for research and specialist treatment of injuries were both ‘halas’. And the PRCS had not lost just one hospital: thirteen clinics and nine hospitals all over Lebanon had been destroyed in this way. Only Gaza Hospital, for a reason I was to discover three years later, was still standing. At the height of the air raids, when the Palestinians found out that every single PRCS hospital and clinic was a bomb target, they put three Israeli soldiers captured in south Lebanon on the upper floors of Gaza Hospital, and radioed a message to the Israeli Army saying that any further military action on Gaza Hospital would result in Israeli lives being lost. That saved Gaza Hospital from further destruction.  

One of the staff who spoke English told us that Akka Hospital had been a five-storey building before the Israeli air raids.  

‘The floor for cardiac bypass operations had just been opened,’ he said. ‘Now there is nothing left.’ Then, as if he suddenly remembered something, he gestured to us to follow him. We went back up the steps: as we came out from the dark basement into the open air we were momentarily blinded by the glare of the sun. We followed him through a maze of half-demolished walls. They had started to clear a large pile of rubble from the twisted remains of what had obviously been a patient’s bed. Next to it was a drip stand, holding half a packet of stale blood. From the label, I could see that once it had fed into the vein of a nine-year-old girl. One of the raids had abruptly ended her treatment, and her life.  

‘My patient,’ said the man quietly.  

We returned to the basement in silence. The Red Crescent staff wanted to give us coffee, but Rio Spirugi firmly refused on our behalf. ‘We have to get going,’ he said, picking up a box used for transporting blood. ‘If we stopped everywhere to drink coffee, we would never get anything done.’ As we were walking up the steps again, he suddenly turned and went back down, to check that all the taps were off. This was very important, because if the municipal water supply came on again litres of precious water could be wasted through sheer carelessness. After he had checked the taps, he made a point of reminding the staff to keep the taps switched off.  

Our next port of call was Gaza Hospital. I liked it at once: it was a majestic eleven-storey building. The top two floors had been severely damaged by bombs, and the ceiling of the ninth floor was full of holes made by bombs and rockets, but there the damage stopped, for the reason I explained earlier. As at Akka Hospital, there was neither running water nor electricity. 

As well as in-patient accommodation, Gaza Hospital had three large operating theatres, a six-bed intensive care unit, a modern blood bank and laboratory, an X-ray department, a large casualty department and an outpatient department. Each floor of the hospital served a different function: Floor One was for intensive care and operating theatres, with attached recovery rooms, Floor Two housed the wards for orthopaedic in-patients, Floor Three was for general medical wards, Floor Four was for general surgical in-patients, and so on.  

Attached to Gaza Hospital was an obstetric and gynaecological hospital, the Ramallah. But apart from a handful of staff, Gaza Hospital was empty. We were told that the patients had been evacuated to temporary hospitals, and that was where most of the staff were working. Apparently Gaza Hospital was in one of the most heavily bombarded areas, and most of the time it was impossible to reach or to leave the hospital. For the past three months the hospital administrator and staff had not left the hospital.  

Immediately before the 1982 invasion, the PRCS in Lebanon was handling an annual turnover of one million clinic attendances and in-patient treatments. All this was entirely free and available to all in need, regardless of race, religion or wealth. Many poor Lebanese people were treated free by the PRCS. Being an entirely humanitarian organisation, and an observer member of the International Committee of the Red Cross, the PRCS would never have expected the Israelis to pick on its hospitals and clinics for bombing raids. When the invasion happened and the PRCS hospitals and clinics were destroyed, the victims of the war lost a valuable medical service just when they most needed it.  

The PRCS evacuated the bulk of their patients and services to temporary hospitals. These were often called field hospitals, but in the Beirut of 1982 no hospital would survive long out in the open. The temporary hospitals were in the basements of buildings, such as the Near East School of Theology, or the Lahut, as it was known locally. Dr Spirugi was very keen for us all to get into action straight away, and he suggested that we start work in Lahut Hospital the following day.  

So off we went to the Lahut, where we found an entire hospital extending for three floors underground, complete with operating theatres, wards and emergency, resuscitation and X-ray facilities. Here, away from the refugee camps and the southern suburbs, right in the middle of Hamra, the Red Crescent continued its work of looking after the sick and wounded. The entire pharmacy of Akka Hospital had been evacuated to the Lahut. Rio introduced us to the staff and asked them to put us to work when we returned in the morning.  

‘You can work here until Gaza Hospital reopens,’ he said, and explained that when that happened he would expect us to provide an initial service until things got sorted out. ‘Don’t forget,’ he added, ‘that most of these people have been through absolute hell for the last three months. They could do with a bit of support. Dr Habib, for example, almost died, and he is still suffering from shell-shock. It’s probably best for him to go on working: if he keeps busy it might take a few things off his mind. But he can’t be pushed. Most of these people have lost homes and members of their families. It’s going to take time for them to recover. You lot are fresh and energetic. Don’t forget that they need your help.’  

Actually I was not particularly fresh and energetic. The fresh and energetic one was Dr Rio Spirugi: he was tireless. I had watched him in action the whole day. He always did three tasks at once, spoke to five or six people simultaneously and was probably thinking through half a dozen projects at the same time. His fiery temper forced everyone into action – and given the chaos and despondency at the time this was a huge achievement. I owe it to Dr Spirugi that I was given the honour and opportunity of working with the Palestinians. It was Rio’s single-mindedness that set me to work almost straight away, first in the Lahut and later in Gaza Hospital. Many of the volunteers who flew out with us never got to work with the war victims, but were sent to north and east Lebanon, where it was relatively calm,  

We got into trouble at the end of the day. Bryan Mayou, the British plastic surgeon, was staying in a Hamra block of flats called the Mayfair Residence. It looked posh, but it had no running water. The nurses’ hostel at the American University, where the women volunteers were staying, did have running water. Although male visitors were strictly forbidden in our hostel, we thought we would be able to conceal Bryan under a large towel and smuggle him into the shower room to have a wash,  

Bryan succeeded in getting to the shower, only to be hauled out minutes later by a very irate warden. Although the sight of a half-clothed, six-foot Englishman being ordered out of the women’s showers made all of us break down into fits of giggles, the incident was regarded as a serious misdemeanour, and it caused considerable embarrassment to our Lebanese hosts. We were reminded that we had to respect local custom: 

it was not considered at all polite for men to invade women’s showers.  

After this little escapade, we had supper in the Relief Centre, a large cafeteria which now functioned as a kind of soup kitchen. In the circumstances, we volunteers were really taken care of very well. I dined on okra, green beans, even a small piece of meat, rice, yoghurt and pitta bread. As I ate my first mouthful, I suddenly realised that I had eaten six meals since arriving in West Beirut without treating one single patient. ‘How awful!’ I said to myself. ‘I shouldn’t be just an extra mouth to feed like this. Tomorrow I must work, and earn my keep.’  

The sun was setting as I walked back with a young Lebanese friend towards the American University. The street lights, presumably working three months before, failed to light up. Through the silhouettes of buildings and rubble, I could still see the beauty of Beirut: the Mediterranean coastline itself, the Flame-of-the-Forest trees, the bougainvilleas coloured purple, white, pink and red, and the large hibiscus flowers. The war had failed to destroy these. 

The cedars made me think of a verse in Psalm 92: ‘The righteous shall flourish like the palm-tree: he shall grow like a cedar in Lebanon.’ Soon the deep red sun sank into the sea, and thousands of stars appeared in the dark blue sky.  

  

A cedar in Lebanon 

Outside the university I could hear, somewhere across the streets, a low, soft singing – in Arabic. My Lebanese friend told me the singers were Palestinian fighters who were going to be evacuated in the morning. I asked him what the words meant, but there were tears in his eyes as he listened to the singing and he could not bring himself to translate for me. He was only a boy, still in his teens perhaps, and the last ten weeks must have been too much for him. I remembered the destruction in Beirut, the hospitals, the wounded and the homeless, and I stopped asking. Maybe I would understand the words of the songs one day – in God’s own good time. Meanwhile it was early to bed for me, so that I would be ready, useful and working in the morning.  

   

Chapter 4  

Early in the morning I was awakened by the sound of continuous machine-gun fire in the distance. It reminded me of waking to the sound of firecrackers at the Chinese New Year in Singapore. I went to sleep once more. Then Jill, one of the nurses from America, woke me up. It was only 6.30 AM. Most of the volunteer medical workers were already up, washed and dressed. They were all planning to go to the harbour to watch the day’s great event – the evacuation of the PLO fighters from Beirut. Looking out of the window, I could see two large patrol boats on the horizon in the distance. My friends told me that one was French and the other was Italian, and that they had been assigned to oversee the evacuation. The international peace-keeping force was moving into Beirut, to protect the civilian population and to prevent the Israelis from taking advantage of the evacuation and the chaos to move into the city.  

‘Are you coming or not, Swee?’ shouted Mary impatiently. She was another of my American nurse colleagues. Should I go with Mary and Jill?  ‘No, I’d better not,’ I replied after a moment’s hesitation. The evacuation of the PLO was clearly going to be a highly political affair, and I did not think I ought to be seen mixed up with a whole lot of PLO fighters. Partly I was scared, maybe, and partly I still saw the PLO as terrorists. At any rate, I had come here to treat wounded people, not to be seen with the PLO. Imagine if the Singapore Government heard I had been messing around with the PLO! What would my Christian friends say? What would my parents think of me? What would my medical colleagues in Britain think of me? The more I thought about it, the more reasons I came up with for not being seen anywhere near those Palestinian fighters. But none of them were reasons I felt like giving to Mary and Jill, so I ended up lying to them.  

‘I’d love to come, Mary,’ I added, ‘but I promised to see some patients in the Lahut. I’ll rely on you to tell me all about it tonight. Have a good day.’  

The two American nurses left without me, and I got ready to go to the Lahut.  

As I walked out of the American University, large red posters greeted my eyes. Bearing slogans in French, Arabic and English, they were hanging from trees, lamp posts and buildings. Many of them said, ‘Goodbye, Beirut, we love you’. Presumably the departing PLO had put them up. The word ‘love’ struck me forcibly: it seemed a strange word for terrorists to use. I hurried on towards Lahut Hospital.  

On the way I stopped to talk to a grief-stricken woman with her young kids in a shelter. Her husband and two sons were to be evacuated, and their home in the south had been destroyed by the Israelis. She showed me photographs of the three who were being evacuated: the younger boy was just fourteen.  

‘But without your husband and your two elder sons, how on earth are you going to manage?’ I asked. ‘How are you going to be able to rebuild your home in the south and bring up your family single-handed?’  

She had not thought that far. She was overwhelmed by the awful thought that once her loved ones embarked on that boat she might never see them again. Her family came from the Gaza Strip: since leaving home in Palestine, they had moved house seven times. This woman had grown used to poverty, war and harassment but now she was weeping because not only was she homeless but her family was being split up. Because I knew I could not console her in her grief, I just shut up and listened. Suddenly she dried her tears and invited me for coffee. How hospitable these people were, despite all the cruel treatment they had suffered!  

This was the first time I realised that PLO fighters were people who had homes and families in Lebanon. They were leaving behind them wives, children, sisters, brothers and parents. The evacuation was forcing the men and women to separate: it was effectively destroying the family structure.  

  

Dr Ang Swee Chai between two PRCS medics in front of Gaza Hospital in 1982 

At Lahut Hospital, I arrived just in time to join the ward round. I was introduced to two doctors who worked for the PRCS, and a British volunteer doctor, Paul Morris. We went round all the patients, and I was introduced as the Singapore orthopaedic specialist sent by Britain’. The fifty or so inpatients were all civilian war casualties, and many of them were children. The main victims of this invasion had been the civilians, unaware that they were going to be the targets of attack.  

There were many sorts of war wounds. Large pieces of shrapnel, sometimes the size of a concrete slab, could easily amputate a limb, or kill someone instantly. There were simple flash burns, and there were deep burns penetrating down to the muscles. By the time I saw them, most of the wounds had been infected for weeks. The most pitiful were the victims of what the American nurses called the Reagan-Begin Syndrome’: typically they were shell-shocked kids, thin and frightened, struck dumb, and refusing food and water. Often all their relatives had been killed in the bombardment. From the medical point of view, the Reagan-Begin Syndrome meant an amputated limb or two, a large chest wound through which the child might well have lost a lung, and a long abdominal wound which had removed parts of the liver, kidney or spleen. There was often an infected open fracture as well. As I treated these kids, the Israeli leader’s words kept ringing in my ears: much as he regretted the casualties, to make an omelette one first had to crack eggs.  

Since I was the only orthopaedic surgeon around, I was asked to take over the management of all the broken bones. Compound fractures, where the broken bones had come through the skin, were very common. I was not entirely happy with the way most of these had been treated. The doctors had tended to go straight for ‘internal fixation’, that is to say they had tried to go in through the wound to fix the bones directly with plates, screws or nails. Then they had generally opted for ‘primary closure’, that is to say, they had stitched up the wound at once. This was a modern approach which undervalued tried and tested traditional methods.  

If they had been treating civilian injuries in well- equipped, clean operating theatres, in Europe or America, immediate internal fixation and primary closure would probably have given acceptable results. But they had been working on blast injuries and gunshot wounds in septic theatres, and internal fixation was a total disaster: just about every case treated that way in a war zone like Beirut developed gangrene, requiring amputation, or chronic bone infection, which was very hard to cure. Under the circumstances, open fractures were best treated by traditional methods: thorough cleansing – cutting away all the dead and contaminated tissues – and lightly covering the wound with a dressing. If an external fracture fixator was available, it could be used to treat the fracture, if not, then splints or traction could be used.  

The wound had to be attended to daily. Once it was healthy, it could be closed with a skin flap or a simple skin graft. Only later, when all the infection had settled, might it be a good idea to do a bone graft or to do internal fixation. It might seem a roundabout approach, but I saw too many injuries go gangrenous through primary closure. The age-old method of leaving all the injuries open initially was still the best.  

If a fracture had to be stabilised so that a patient could be evacuated or transported, and if an external fixator was not available, then a splint, such as the Thomas splint designed by Hugh Owen Thomas of Liverpool, which again was tried and tested, was just as good, or even simply a plaster of Paris cast.  

In the chaos of air raids, with dozens of volunteers from all over the world, all of whom insisted in doing things the way they thought best, I found it difficult to ensure that these very basic but also very safe principles of fracture care were implemented.  

Once the Palestinian fighters had been evacuated, peace did return to West Beirut. The air raids stopped altogether. There was no shelling, and people came out from their shelters and hiding places, and headed for home again. I left the nurses’ hostel in the American University as the nurses started to return to work, and moved in with the rest of the volunteers in the Mayfair Residence. But it became inconvenient for us to commute to Gaza Hospital daily, so our volunteer surgical team moved into the hospital, where we were allotted a large, empty suite on the ninth floor. The windows were broken, but otherwise the bomb damage at our end of the building was minimal. It was great to be so high up: the mosquitoes could not get us, and it was cool at night.  

Moving into Gaza Hospital made me realise what a hopeless home-maker I had always been. My colleagues worked diligently setting up the ‘foreign doctors’ quarters’. First they swept the floor clean of concrete debris; then they bought domestic items such as a gas cooker, a kettle, pots and pans, and groceries, and bit by bit made the empty deserted suite a homely place. 

Meanwhile the patients were gradually moved back from the temporary treatment centres – the Lahut, the Protestant College, and so on – and started filling the wards of Gaza Hospital. As the patients were still in more than one place, I was doing rounds in the Lahut as well as Gaza Hospital. There was not much by way of surgery that I could do then, since our limited resources had to be husbanded for emergencies, and so my job was limited to debriding wounds (that is to say, trimming and cleaning them by removing damaged tissue), changing plaster casts and sorting out antibiotics. Some of the patients were on eight different antibiotics and quickly becoming resistant to all eight. Working out some sort of antibiotic policy was important. It was also not very easy.  

One day I was waiting for the jeep to take me from Gaza Hospital to the Lahut, and I fell into conversation with a PRCS nurse. I asked her if it was possible for me to visit the ‘camps’. After all, everyone was always talking about the refugee camps, and I felt as if I was the only one who had never visited them. This was a few days after we had started working at Gaza.  

‘Camps?’ asked the nurse. Then she smiled, took me by the hand and led me through the door of the hospital. A narrow lane separated the hospital from a long row of multistorey buildings – a mixture of shops and flats. We turned right, and walked a few metres down the road to the market which I passed every day, where Dr Egon bought oranges, tomatoes and vegetables for our apartment. There was a mosque by the market, and more blocks of flats and shops. Women with white, black and many-coloured scarves around their hair were hurrying to and fro with their shopping. Kids were pushing wheelbarrows laden with bricks and building materials towards destroyed buildings. Everywhere people were repairing their homes.  

The nurse from Gaza Hospital put her arms around me. 

‘Doctora Swee,’ she said, ‘welcome to Sabra and Shatila!’  

This bustling market with its vegetable and fruit stalls, and its livestock, was Sabra market. The buildings all around it were Shatila Camp. The buildings around Gaza Hospital were Sabra Camp.  

For the last few days I had been eagerly watching families returning to rebuild the bombed-out buildings. Every morning I had looked out of the window on the ninth floor of Gaza Hospital and had seen new arrivals coming with their scanty belongings – cases, mattresses, pillows – to occupy broken buildings. One day they would move in somewhere covered with dirt and dust, with shattered windows, and holes in the walls. The next morning I would look again: the same building would be transformed. Freshly-laid bricks would have patched the holes in the walls, new windows would have been put in, laundry would be hanging out to dry, and the laughter of children could be heard. I had thought this was just part of West Beirut getting back to some kind of normality, and all the time I had been right bang in the middle of the camps!  

My mental image of a refugee camp is something like a large field covered with rows of tents. ‘So where are the tents?’ I asked the nurse. ‘It’s supposed to be a camp, isn’t it?’ 

She explained that when the Palestinians in northern Galilee had been uprooted in 1948, many of them had walked across the northern border into Lebanon. The Galileans became refugees in Lebanon; other communities from the rest of Palestine fled to Jordan, Egypt, Syria, Iraq and all over the Arab world. Atlases no longer had maps of Palestine, but that did not stop the 750,000 exiles from remembering their homeland.  

It was hoped then that the refugees would be ‘absorbed’ into the neighbouring Arab countries, and thus join the countless communities which have been erased from history. The UN, together with several humanitarian and relief organisations, supplied tents and set up refugee camps for the newly homeless Palestinians. The Galileans found themselves in some of these ‘temporary’ camps – Sabra, Shatila and Bourj el-Brajneh in the southern suburbs of Beirut.  

The nurse from Gaza Hospital explained to me that the refugees had not been ‘absorbed’, because they were not truly refugees. They were exiles, and there was a difference. As exiles, they always wanted to return home. The tents had soon been demolished – by the Galileans themselves. In exile, from their memories, from bits of pictures of their homes, they had begun to rebuild their own community. Many of the houses were carefully built to look like their beloved homeland. As the tents made way for brick houses and flats, so the camps became exile towns, with kindergartens, schools, workshops, clinics and hospitals. They named their hospitals Gaza, Haifa and Akka after towns in Palestine so that they would never forget their roots.  

Apart from the lack of tents, and the fact that the refugees were exiles, there was another popular misconception about the ‘Palestinian refugee camps’: the word ‘Palestinian’. It was true that the camps had originally been set up for the refugees from Palestine. However, the Palestinians had transformed their deprivation into a principle of non-discrimination which pervaded all their institutions, and so the camps had never been for the Palestinians alone.  

The hospitals run by the Palestine Red Crescent Society gave free treatment to all in need. They did not quibble about country of origin, or race, or religion, the nurse reminded me. The Palestinian schools provided free education for all. Their vocational institutions and their women’s organisations ran an open-door policy. As a result, over a third of the people in Sabra and Shatila were not Palestinians, but Lebanese who identified with the Palestinians through bonds of poverty and deprivation.  

Most surprising of all, said the nurse, were the Jewish families living in the middle of the camps: not many, but these were Jewish families who had left in protest along with the Galilean exiles, and had stayed with the folks in the camp. 

A fifth of the Palestinians were Christians.  

My nurse laughed, for my face was a picture of bewilderment caused by ignorance. She invited me to her home for coffee, but I turned down the invitation as I had to catch the hospital jeep to the Lahut.  

‘Bokra,’ I said, flaunting the second Arabic word I had learnt, which meant ‘tomorrow’.  

The next day, when I returned to the camps, the place was even busier: the rebuilding of the camps was in full swing. More families had returned. The hospitals were bustling and full of life, and those hospital staff who had escaped imprisonment or death were back in full force. They were clearing rubble, scrubbing the hospital floors, taking stock of medical supplies and transporting beds and equipment up and down the floors so as to get the wards ready for the patients. Akka Hospital, which had been merely a mess of rubble when we had visited it the week before, was now swept clean and the ground floor had been refurbished. Heaps of bricks and steel pipes had been brought in, presumably to rebuild the hospital.  

This was a very exciting time: for once, I felt part of the vibrant force of creation. How I wished Francis could have been there, so that he could share this wonderful spirit! Israel’s military might had failed to destroy this. I wished I had taught him first aid. I could have brought Francis along as an ambulance driver! We two were refugees, but we had to learn from these camp folks – from their will to survive and to turn the existing nightmare of a wartorn camp into proper homes. Suddenly I burned with the instincts of home-making and longed to decorate our tiny flat in crowded central London with hundreds and hundreds of bunches of flowers. Here in Sabra and Shatila, in the midst of poverty and persecution, life, abundant life, had returned, and no one and nothing could take that away from the camp folks – not the bombs, not the shells, not even the pain of evacuation. 

Every morning from then on, I would run to the sixth floor of Gaza Hospital to share breakfast with the PRCS doctors and nurses. I would make them talk to me about the camp, about themselves, while I looked out of the window, eager to study the changes in the camp homes: new doors, new windows, freshly-painted walls, holes patched up overnight. I admired the diligence of these people.  

The official reopening of Gaza Hospital was set for 29 August 1982, but people were visiting the hospital days before that for all sorts of treatment. They came because of coughs and colds, and to get treatment for war wounds which were two or three months old. The people in the camps referred to Gaza as their hospital: they loved to tell me the story of how the head of the PLO, Yasser Arafat, whom they called Abu Amar, had refused treatment from the sophisticated American University Hospital when he had been taken ill, and had chosen Gaza Hospital instead.  

The staff of Gaza Hospital, all employees of the PRCS, were very courageous people. There was never the slightest murmur of complaint from any of them, and their extreme stoicism made it easy for us foreign volunteers to forget that, like everyone else in the camps, they too had lost homes or loved ones. In particular, I remember a young Palestinian orthopaedic surgeon from south Lebanon: he was a devout Muslim, and rose early each day to pray. During the Israeli invasion of Lebanon, he had refused to leave his hospital in the south until all the patients and staff had left and he had been ordered out. The war had cost him nineteen kilograms in weight, his home and his hospital in the south. Far from being bitter or resentful, however, the young orthopaedic surgeon plunged into the task of rebuilding Gaza Hospital.  

The medical director of Gaza Hospital was Amir Hamawi, a young Lebanese surgeon. His cheerful, sunny disposition, his diligence and his warm enthusiasm certainly made life much more bearable for many others. Lebanese and 

Palestinian doctors and nurses worked side by side in Gaza in complete harmony. The professor of general surgery was one of Beirut’s top specialists, but he was a very quiet, modest and unassuming man. I learnt a lot from him, and I also tried to learn from his opposite number, the co-ordinator of medical staff, a disciplinarian who did his ward round in the style of a commander-in-chief inspecting his troops. I thought this a very useful tactic, but try as I might to copy his style, I never succeeded in marshalling that much respect.  

We, the foreign medical volunteers, were of diverse backgrounds, and that sometimes created problems. The PRCS medical staff were always courteous and friendly towards us. However, some of my colleagues from the West were rude and loud, and some tried to conceal their inexperience and incompetence under a cloak of blustering immodesty. This problem was not peculiar to volunteer health and relief workers in Lebanon: it was generally the case where volunteers from ‘developed’ countries thought that they ought to be one up on the ‘natives’. Some of my more ignorant and patronising colleagues could not bring themselves to acknowledge the fact that Gaza’s professor of surgery was a specialist of international standing long before they had even entered medical school.  

Moreover, doctors from western countries did not always find it easy to appreciate that Lebanese and Palestinian doctors had stacked up many years of practical experience in dealing with war wounds. The western doctors had no such experience unless they had been in a war zone like Korea or Vietnam.  

Although Gaza was functioning again, there was still no water or electricity from the mains. Electricity came from the hospital generator, which ran on rationed diesel oil. There was usually enough fuel for three hours a day.  

As soon as the generator started running, there would be a sudden burst of activity. Water was pumped up to the tanks on the higher floors. Toilets were flushed and washed. Laboratory equipment started working: investigations and Xrays were carried out. The lifts started moving: patients and equipment were transported from floor to floor. The operating theatres lit up: operations were carried out. All too soon, the three hours would be up, it would be black-out time once more and candles would be lit. Any transporting of patients from one floor to another would have to be done by hand, as the lifts were dead again.  

One day a patient was brought in during a black-out. He had returned, like many others, to live in the camps, but he had found his home and family wiped out by an air raid. In his despair, he had tried to take his own life by drinking a bottle of organophosphorus. This is an insecticide, a powerful poison which attacks a vital body enzyme called cholinesterase. Convulsions, severe colic, respiratory arrest and cardiac arrest then result. Atropine in high doses is the antidote, but even in the best of circumstances the victims of organophosphorus poisoning usually go under and die. He needed help in breathing, and was artificially ventilated for a week. Because there was no electricity, ventilation had to be carried out by hand. We all took turns squeezing the bag, and in the end the poison wore off and he recovered consciousness. He did some thinking, and became more positive and glad to be alive. It was a credit to the anaesthetics department that this young man – against all the odds – survived.  

Throughout the entire Israeli invasion, the siege of Beirut and its aftermath, the administrator of Gaza Hospital was Azziza Khalidi, a fine young Lebanese-Palestinian. She was extremely bright, with a PhD from the American University of Beirut at the age of twenty-six.  

Behind the fair complexion and the bright, beautiful and apparently permanent smile was an extremely competent administrator. Azziza’s was a difficult task during a chaotic time. Everything was difficult. There were staff shortages and shortages of equipment. There were political pressures. On top of everything else there were impatient and bad-tempered foreign volunteers who seemed unable to grasp that after three months of air raids and shelling Beirut was not like London or New York where a hospital administrator simply had to pick up the phone to order supplies. Some of them also found it hard to accept that operating theatres with large shell holes in the walls which lacked electricity and running water should only be used for the most urgent, life-saving operations.  

Although we were not all aware of it, Azziza also had to deal with the personal and social lives of her staff, who might be homeless, or might have lost their loved ones through evacuation or because of death. In addition, Gaza Hospital was not just a hospital, but was also a welfare centre where the camp folks brought all their financial and domestic problems. What could you say to the mother of six young children who between them had lost five limbs, when she had neither husband nor grown-up son to be the family breadwinner? Many of the problems were insoluble.  

Community medicine was very nearly my chosen specialisation. Realising I knew little of my own society in Singapore, I left the hothouse hospital atmosphere and spent two years at Singapore University’s faculty of community medicine. While based there, I visited factories and learnt about lead poisoning, noise-induced deafness and industrial accidents. I also studied maternal and child health. There were clear links, in my view, between disease and poverty and ignorance. A doctor could act as a technician trying to put right the effects of a whole series of causes, but a doctor could also try to eliminate the basic causes of illness.  

Trying to hit at the root causes of illness is not easy: as well as using medical technology, it involves educating the public and trying to influence the powerful. It was all too much for me: I did get a gold medal for my community medicine studies, but I also had to leave the department, because I had upset too many bureaucrats and academics. 

I returned to hospital practice. Tucked away in the wards and operating theatres, doing a hundred hours a week, I could not make trouble by preaching that unequal distribution of wealth resulted in unequal distribution of health. It was better to treat streptococcal infections in young people than to treat late complications of these infections with heart and kidney transplants – but stating such obvious truths was now offlimits. I became a skilled technician once more, and I chose to train as a surgeon, since surgery combined aspects of three subjects I loved: medicine, cookery and sewing. (Work it out.) I concentrated on minding my own business and doing a competent job once more.  

Although I was now a surgeon, I was well aware of the way Azziza and her team extended the hospital’s role so that it tried to meet the social needs of the community as well. People would come to Azziza for food – usually bread – or building materials for their homes, or jobs. In the middle of all these demands on her, our young hospital administrator never lost her cool.  

Of course, she also had some extremely good and loyal staff, most of whom were women. They had refused to abandon the hospital during the war, even at the height of the bombing, when they would have been safer elsewhere. They simply refused to jump ship! Those Arab women with their gentle and graceful ways really restored my faith in the strength of women. 

  

Swee operating, without mask, gloves, anaesthetic or electricity – Shatila, 1985. 

   

Chapter 5  

A week after the official reopening of the hospital, we had sixty in-patients and a waiting list of twice as many again. Three quarters of the in-patients were orthopaedic patients, but the hospital’s senior orthopaedic surgeon had been evacuated, and so I was put in charge of the Orthopaedic Department. Although I knew I was too inexperienced for this job, there was no one else around, and I had to accept the responsibility. What I lacked in experience, I tried to make up for with hard work, because I soon came to love and respect these people deeply. I just wished I was stronger, and could make do with less sleep. The need was pressing: I could have worked continuously, resting only when there was no electricity or no water. Even then it was often possible to do smaller operations using local anaesthetic, with a nurse holding a torch.  

  

Swee filing X-rays in her specialist orthopaedic clinic in Shatila, 1985. 

In the evening, I used to take walks around Sabra and Shatila. These are now among my fondest memories of those early days. Feeling completely at home, I would enjoy the hospitality of the families in the camps. No matter what misfortunes had befallen them, I was always greeted kindly and welcomed into their homes. Sometimes a home might have been reduced to broken walls, but it did not matter. The floor would always have been swept extremely clean, and I would invariably be offered Arabic coffee. I had not encountered such hospitality for a long time – not since leaving South East Asia, where rural Malays and Chinese fisher folk always welcomed strangers into their homes with open arms. The people in the camps would share their family pictures with a stranger like me, pictures of their loved ones, of weddings, of births and of their Palestine. They would often try to give me some of their few precious belongings.  

The girls would frequently remove their earrings, their bracelets or other bits of jewellery and force them on me. The really poor people would try to make me accept their family pictures, or pieces of cloth such as tea towels. I soon learnt never to make a complimentary remark about any household item in a Palestinian home, because it would certainly be offered to me as a gift. Their generosity often made me deeply ashamed of my own selfishness. I was a Christian on a 

‘mercy’ mission; I had been hailed as a ‘Lady of Mercy’ by 

Singapore’s press, but I had so little to give these folks, and in fact received from them the best humanity had to offer a thousand times over. In the camps, in Gaza Hospital, with people who enlightened me through their attitudes and their actions, I felt closer to God than ever before.  

Gaza Hospital went from strength to strength. We got busier and busier by the day: the wards filled up, and more and more operations could be carried out as the water and electricity supplies improved. Many nurses emerged from hiding and came back to the hospital. Among them were the very skilled and experienced ones. They became among my best friends during my time in the camps. Autoclaves, X-ray machines and laboratory facilities were gradually brought back into action. A fortnight after the official opening, Gaza Hospital was in full swing.  

The hospital routine consisted of morning ward rounds and clinical case conferences, followed by out-patient and specialist clinics, operating sessions and then, for the medical staff who were on call that day, work in the emergency room. My own work had started to expand into the area of nontrauma or ‘cold’ orthopaedics. This included looking after patients with congenital orthopaedic problems such as club feet or hip dislocations, and patients with degenerative conditions like osteoarthritis and backache. People started to turn up with the sort of injuries I associated with civilian life, such as domestic fractures, cuts and burns.  

The hospital received visits from outside groups, prominent among them being journalists and television crews. Although I found the television visits fairly distracting, I did appreciate the importance of the media. They helped to remind the outside world of the camps and their people. Up till then the media had focused on the war and destruction: now we hoped it would capture the optimistic mood in the camps as their people plunged wholeheartedly into the work of reconstruction. Perhaps just this once, I hoped, the will of the people to survive and put their broken lives together would strike a chord in the hearts of people in the west.  

Our patients were eager to talk to the journalists about the war. At first they were camera-shy, but after a while they would pour their hearts out and recount the horrible events of the war. They would show their anger at those injustices, but many of them obviously felt triumphant, and were proud that nothing could break their spirit.  

The children in my orthopaedic ward were incredible. Little Essau, a Christian Palestinian boy with short, curly, black hair, had been wounded by the same cluster bomb which killed his mother. Both his legs had been broken in many places by the explosion. Many of Essau’s wounds were septic, and he needed an orthopaedic operation to remove the dead and septic bones. After the operation, his fractures needed to be set straight so his legs would not be crooked. Whenever reporters came to his ward, Essau would usually start by telling them that when he grew up he was going to be a ‘fighter’, so as to defend his people and his camp. Before he could be labelled a ‘terrorist’ by the reporters, a nurse would pull back his sheets to reveal a pair of scarred and crooked legs riddled with large, festering wounds. Seven-year-old Essau would look down, and fall silent. None of us were sure if he would even walk again, let alone become a ‘fighter’ when he grew up.  

Milad Faroukh was an eight-year-old Lebanese boy whose father once had a farm in south Lebanon. The farm had been destroyed by Israeli bombs, and one of the bombs had fallen on to the field where Milad was playing frisbee with his little brother. His brother was killed outright, and Milad’s heel was blown off. My British colleague Dr Paul Morris spent hours and hours patiently trying to talk him out of his withdrawn state and persuading him to eat. At last he succeeded, and Milad started to eat something. He had been reduced to skin and bones, but now he made a steady recovery. The first time Milad smiled, we all thought an angel was smiling in wartorn Lebanon, so beautiful was his face.  

Although he remained shy and reserved, Milad became very brave, and soon started learning how to change his own dressings. As he peeled off the bandages from his heel, a large, raw crater was revealed. It must have been agony, but he gritted his teeth and bravely washed his wound with hydrogen peroxide before dressing it.  

There was also Leila. When we changed the dressings on her large, raw burns, her mother and the nurses all knew that she was in agony. Such large wounds on a three-year-old really ought to have been dressed under a general anaesthetic, but there was a shortage of drugs. We had to make do with what we called a ‘vocal anaesthetic’: Leila’s mother and the nurses talking or shouting the little child into co-operation.  

From all over the place came more children – children with war wounds, children with pieces of shrapnel: very, very brave children on whose bodies the advanced technology of modern warfare cruelly left its indelible marks. Many of the kids were now orphaned and homeless, and had found temporary shelter with neighbours or distant relatives.  

Many times I quietly prayed for strength, prayed to God to help me cope. The most straightforward operation could he turned into a complicated nightmare by a sudden power cut. Sometimes the nurses were down to dressing wounds with nothing more than soap and water. This was the aftermath of war, but at least there was a ceasefire. The camp folks were glad the bombs and shells had stopped falling. Occasionally an unexploded bomb or a landmine would go off and claim its unwary victims, but as the days passed such incidents became less frequent. Outside the camps, major political events were unfolding.  

Various ‘peace plans’ were being discussed. Events which attracted our attention on the BBC news, such as the restoration of the Lebanese Parliament, became the talk of the markets, the streets and the taxi drivers. Multinational peacekeeping forces were stationed in many places, and were well-accepted by the local people. We were told that the peacekeeping forces would remain till the President-elect of Lebanon, Bashir Gemayel, had been sworn into office and the Lebanese Army had been able to regain control of the country.  

After nearly a decade of civil war, Lebanon had become a place full of armed militias. Many private individuals owned a machine gun or at least a pistol. Private organisations owned rocket-launchers and even tanks. Now a major disarmament exercise took place: this war-weary country was prepared to have a real go at peace. Throughout Beirut the people gave up their guns, and units of the Lebanese Army toured the cities and the camps calling on people to turn in their weapons. Arms depots were emptied by the army.  

Everyone thought that this time they would see an end to war. The price of a Kalashnikov plummeted to seven Lebanese lira (about £2.50 sterling). I saw women going up to surrender their sons’ weapons. People trusted the peace proposals, and they were prepared to show that they wanted peace. Sandbags, roadblocks and landmines were gradually cleared. Roads which had been blocked by large heaps of sand were cleared so that large vehicles could use them. Bulldozers were kept extremely busy clearing roads and war debris. 

Shops reopened. Piped water returned and the ‘electricity of the government’ became available once more.  

Hamra came back to life, and various luxury items were available again. I acquired a taste for croissants, a French delicacy which was totally alien to the Singaporean tongue.  

There was a postwar euphoria: the local population was both enthusiastic and united. When asked if they were 

Lebanese or Palestinian, people often answered, ‘Both,’ and said that there was no difference between the two communities. Far from dividing the two peoples, the invasion had obviously united them in their common hatred of the Israelis. People would drag me along to see the bombed-out buildings.  

‘Look, doctora,’ they would say. ‘Shops, hotels – Israeli rockets and bombs make “whoosh”, and now no more shops, houses and hotels.’ The wreckage spoke for itself.  

Tuesday, 14 September 1982, was a good day. The roads were entirely cleared of road blocks. The hospital’s water supply had been restored, as had the electricity. It was so good to have electric lighting and to be able to wash my hands under a running tap. Dr Phil McKenna, my anaesthetist colleague from Ireland – a wonderful friend – decided to reorganise the whole emergency room. ‘Now that the war is over,’ she said, ‘we can establish some sort of system.’  

She went downstairs, asked for a towel, and wiped the tables and trolleys in the emergency room. Then she sat down to sort out the resuscitation equipment: all the endotracheal tubes she arranged by size, the laryngoscopes were checked, as were the anaesthetic gases, the machine connections and even the gauze and bandages. 

As I had finished operating, I came down to help the nurses prepare surgical dressings. We cut large pieces of gauze into smaller pieces, and then folded them into little squares. We prepared abdominal packs by stitching the edges of large pieces of folded gauze. Cotton wool balls were rolled and packed for the newly-functioning autoclave. Then everything was laid out ready for use the next day. Helping make the dressings was wonderfully relaxing – it was my favourite job of the day. I got to know the nurses, and picked up some more bits of Arabic.  

Abu Ali, the operating theatre superintendent, was in his early middle age, and spoke good English. He was an especially proud and happy man that day, because he was celebrating the successful wiring of the autoclave. From then on, it was going to be possible to autoclave’ all surgical instruments. Abu Ali started to explain to the student nurses the differences between sterilising surgical instruments using the autoclave, which he called steam heat’, and sterilising them using boiling water, which he called ‘water heat’. The autoclave was more effective for a number of reasons, which he explained, and I nodded in approval.  

Abu Ali had a very stabilising influence on me, because somehow he managed to produce all the surgical instruments required for my operations. This was more than many theatre nurses in British hospitals could do. Often I held back from asking for sophisticated orthopaedic instruments, because I did not want the Gaza theatre staff to feel inadequate. Frequently, to my absolute delight and amazement, one of the instruments I needed to use, but dared not ask for, would be put into my hands by one of the scrub nurses. Time and time again I was told by this excellent theatre superintendent that there was no need to compromise good surgical standards for expediency.  

The PRCS theatre staff were obviously very proud of their own work, and tried to keep standards up. Sometimes Abu Ali would shake his head ruefully and tell me, ‘Before the invasion we had a good working system, but unfortunately our system was destroyed by the war. However, we are now beginning to re-establish our standards.’  

That night I went to bed early, feeling very satisfied and looking forward to the next day’s work. We had scheduled some fairly major orthopaedic reconstructive cases for the next day – three cases with infected fractures of the lower limbs which had not united, one burn case with about ten per cent area to skingraft, and a few smaller operations.  

I was woken up at eleven o’clock that night by a loud bang. It sounded like an explosion far away, but the whole building was vibrating from it. None of us knew what it could be. The midnight news confirmed that a large bomb had gone off in East Beirut, and that the President-elect of Lebanon, Bashir Gemayel, had been among those assassinated. We were all shocked by this news. Could it mean that there was going to be trouble again?