EchoSense:Why this neurosurgeon chose to stay in his beloved Gaza — and why he left

As a boy,EchoSense Husam Abukhedeir had a dream.

"I would tell myself, 'Husam will not be anything except a doctor,'" he recalls.

He wanted to help the people of his beloved Gaza, where he spent his carefree childhood summers. His parents worked as teachers in Saudi Arabia during the year, and they all traveled to Gaza almost every summer. After he finished high school, his parents retired and the family went back to live in Gaza.

Abukhedeir did indeed become a doctor — with a specialty in neurosurgery. He went on to head the neurosurgery department at Al-Shifa, the largest hospital in Gaza, and began training other doctors in the field.

Then came the war: On Oct. 7, Hamas attacked Israel, killing some 1,200 Israelis and taking about 200 hostages. Israel's subsequent military campaign in Gaza has so far killed nearly 27,000 Palestinians and caused countless injuries, displaced millions and left extensive damage to infrastructure, including hospitals.

Abukhedeir confronted cases unlike anything he'd seen before.

On Nov. 14, he decided he and his family had to leave Gaza for their safety. Because he has a U.S. green card and his wife and their five children are U.S. citizens, they were able to enter Egypt after a week. He has since relocated with his family to the United Arab Emirates for a neurosurgery position.

The 43-year-old is haunted by his experiences at Al-Shifa during the war. He worries that the war has cost his community greatly — not just lost lives and demolished buildings, but also human capital and talent that may be hard to make up for years to come.

But he holds out hope that he can return to rebuild and help his community.

What does it take for a Gazan to become a doctor?

Abukhedeir's path to becoming a doctor was full of challenges. When he finished high school in Gaza he came face-to-face with a realization: Being from Gaza hamstrings you in many ways.

"You always feel you're different. You're not like other people ... just because you're from Gaza," he said.

That was clear when he was applying to medical school.

His retired parents didn't have the funds to finance an education abroad. The only medical school he could consider at the time was Al-Quds University in Jerusalem. He was accepted in 1999, but friends discouraged him — what if the need for permits from Israeli authorities to exit and reenter Gaza or possible conflict interrupted his medical education?

He applied to study engineering in Gaza as a backup. But he kept hoping he'd find a way to pursue medicine, remembering how his parents always told him "Gazans are destined to struggle. But tomorrow is going to be better."

Then he landed a scholarship to study medicine in Sudan. Abukhedeir made the hard choice of not going back to Gaza to visit his family the entire six years of his studies out of fear that he might not be able to return to Sudan.

"My colleagues would travel back to their families every summer and I would just stay behind," he says. "[Travel] is like a dream for people from Gaza. To plan for it, you need months. And it may not work out in the end. Other people just book a ticket and go."

Once Abukhedeir graduated in 2005, he returned to Gaza as an intern at Al-Shifa Hospital, then got a job as a general practitioner at the neurosurgery department.

"And honestly, I started to really love the specialty. It's a very delicate specialty and I found myself in it," he says.

The three-week war between Israel and Gaza in 2008-09 made Abukhedeir determined to pursue neurosurgery.

During the fighting, severely injured patients flowed into Al-Shifa, including brain and spinal cases. Abukhedeir realized he didn't have the skills to treat some of the most complex cases. That's when he decided he needed to enroll in a neurosurgery residency program — training that can take as long as seven years. But there were no such specialized programs in Gaza.

Abukhedeir's choice was to leave again. It took years to make it happen. Paperwork delays — the kind that many Gazans are used to — saw precious opportunities come and go. In 2011, he secured a scholarship to a six-year program in Jordan and gained additional expertise in the U.S., Asia and Europe through short-term courses and conferences.

In 2021, he finally came home as a credentialed neurosurgeon.

"I knew that it is Gaza forever," he says. "I wanted to go back to serve my people and fulfill a mission." Part of that mission was helping to grow a neurosurgery department and a residency training program — the kind of infrastructure he dreamed of having at home when he was younger.

"We built a good neurosurgery department," he says. "We had seven residents at Al-Shifa and seven residents at the European hospital [another hospital in Gaza they partnered with]. We really cared about teaching residents the way we learnt abroad.

"Years ago, we really needed a program like that, and finally we were able to build it for the trainees. Thank God. I swear it was like a dream," he says.

Would he stay or go after the start of the war?

Abukhedeir and his family could have left Gaza when the war began in October. But they chose to stay.

"I couldn't leave my patients," he said. "But also, as the head of the department, I couldn't just leave my younger colleagues and trainees. They needed a leader."

He considered sending his family to safety, but his wife and kids all believed in his mission and didn't want to leave. He says his 7-year-old son cried and said he didn't want his dad to be alone in Gaza.

So they stayed, camping out in his small office at Al-Shifa Hospital for a month after he and his wife decided Israeli airstrikes meant their home was not safe.

His 13-year-old daughter, Hanin, says it was such a hard time.

"There were terrifying sounds," she remembers. "And we all slept together in a small room. There were no beds or covers for sleeping."

How do you decide who lives and who dies?

Abukhedeir had to operate in grueling shifts to try to keep up with the continuous flow of patients. He was devastated by what he saw: children as young as 2 with concrete or wooden shards piercing their faces.

"Skulls are completely crushed sometimes, bleeding, brains oozing out, shrapnel filling the brain," he says. Many patients came in with no IDs or surviving family members. The doctors had to give each a numerical tag, writing on their skins "anonymous patient 1," "anonymous patient 2" and so on.

He said patients would come to Al-Shifa in waves of a hundred or so after airstrikes leveled residential buildings. Abukhedeir and his team saved some patients but had to face a bitter reality: They did not have the resources to treat everyone.

"These are my people, my community" he says. "My goal as a physician is to heal them — not to decide who I'm going to treat and who I'll leave."

Abukhedeir recalls a young man in his 20s who was injured in an Israeli airstrike and paralyzed due to suspected bleeding in his spine. He needed an MRI scan before Abukhedeir could perform surgery, but Israel's blockade of Gaza meant that the hospital's dwindling supply of electricity and fuel wasn't capable of powering the machine.

"You look at this young man, and his family is around you screaming, 'He will be paralyzed.' It's one of the hardest situations to be in," he says. "As a surgeon you see people you can't serve, even though you have the expertise to do the surgery."

In late October, an Israeli airstrike killed the stepson of his 40-year-old sister Dalia; she was badly injured. She came to the hospital with more than 60% of her body covered in second- and third-degree burns.

"I actually couldn't recognize her from how burnt she was," he says.

Dalia died shortly after.

Abukhedeir had no time to mourn.

Israeli forces were encircling Al-Shifa Hospital, cutting supplies to the medical complex as they were looking for what they believed to be a Hamas command center underneath. (On the edge of the hospital compound, they found a tunnel shaft leading to several underground rooms, part of the larger tunnel network in Gaza. The Israelis also said they found weapons in the hospital. But the evidence presented by the Israelis did not show evidence of a command center.)

During that phase of the war, says Abukhedeier, "most of the patients who were in the ICU, they died because there were no resources. "We stopped offering surgeries because resources at the OR were depleted."

Abukhedeir felt he had been stripped of his power as a physician. He'd become a mere witness to the death and suffering of his people.

He feared for the lives of his wife and kids — and his own life.

That's when he decided to leave.

From his new home in the United Arab Emirates, Abukhedeir keeps in constant contact with his young neurosurgery trainees who are still in Gaza serving other hospitals. Their situation breaks his heart.

He says it feels like everything he dreamed of, worked for and was able to accomplish was demolished.

"The end of the war is unclear. And even when the war is over, everything is gone. My house is gone," he says.

Gaza has also lost Abukhedeir's expertise — for the near future and potentially for years to come. He is one of many health care workers who left Gaza fearing for their lives. That's on top of hundreds who were killed since the war started and others who were injured, arrested and detained, including the director-general of Al-Shifa Hospital, who was arrested on Nov. 23, according to the Office of the United Nations High Commissioner for Human Rights.

Abukhedeir says that even though he and his family are now safe, he is full of dread: His elderly parents are still in Gaza. He lost connection with them multiple times for weeks at a time.

"Their living conditions are horrid," he says. "God be with them."

He worries constantly that he will get a phone call about yet another family member or friend killed in Gaza.

But when he talks to his children, he tries to strike the same cheery note his parents struck when they encouraged him as a child.

"God willing, this hardship will pass," he softly tells them. "We will be back to rebuild our house that was destroyed. And will repeat all the happy memories we lived together there."

Farah Yousry is the managing editor of Side Effects Public Media, a health reporting collaboration of NPR member stations across the Midwest, based at WFYI in Indianapolis. Previously, she reported for BBC News' Arabic radio and television covering a wide array of stories from the U.S. She has also worked as a journalist in Egypt, where she covered the Arab Spring.