Gaza Strip - March 19, 2009

Joanna Kotcher, Merlin's Health Coordinator in Gaza, is a nurse specializing in conflict and refugee health and has 13 years experience in humanitarian aid in conflict zones. Merlin, a global medical aid organization, entered Gaza February 11, 2009 and has partnered with Palestine Medical Relief Society (PMRS) to provide support to Gaza's devastated health system.

I've been in the Gaza Strip for several weeks to assess the ongoing crisis. Our goal is to implement appropriate assistance for the people trapped in this profoundly damaged environment.

It is difficult to describe the level of destruction that fills the landscape here. In the 13 years I have worked in the humanitarian aid sector, I've never witnessed such widespread devastation.

Traveling through the districts of North Gaza and Rafah during our first assessment, we saw dozens of concrete buildings turned sideways or collapsed - their multi-story roofs folded in and compressed. Steel girders, sheets of metal, and concrete columns jutted into the sky.

Homes, schools, and businesses are in ruins and farmlands are now useless and dangerous to anyone walking through them.

Among the dust and debris there is unexploded ordinance, including residual white phosphorus, which can maim without warning.

I listen and participate in the clinical discussion on treatment of white phosphorus burns with my colleagues from the Mines Advisory Group. Meanwhile, the personal and highly emotional side of me places the information deep into my psyche, to be retrieved and processed later with the sights, smells, and sounds of this war.

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It is raining and the air is wet and cold in North Gaza. Traveling with the Palestinian Medical Relief Society, PMRS, we will visit a community in one of the districts most heavily affected by the bombing.

We wind our way along roads lined with collapsed buildings and arrive at the mobile clinic site. It's a white tent topped with a small flag dwarfed by giant fallen concrete slabs. But its purpose is clear: medical help.

The rain has forced the mobile clinic team and patients to retreat into a nearby building - the only building standing within sight. Women and children climb the stairs to the third floor where the team of doctors and nurses are seeing patients.

This is clearly a makeshift clinic. The three rooms reveal evidence that a family had once lived there - and then fled.

A dusty wedding photograph hangs askew on the wall; the mirrored doors of a wooden wardrobe are shattered in hundreds of pieces, and the inevitable blast holes in the walls are stuffed with paper and cloth to keep out the rain.

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Patients wait on floor mats or narrow cots left behind by the former residents. The women are shy, but eager to talk. Through gestures and tears, one mother recounts the trauma she experienced during the bombing.

Many more women and children will tell me their stories. Each person has a history to tell - and once they feel that someone can hear them, they talk openly with and surprising candor.

During the second phase of the field assessment, our small team travels in a convoy to visit the southern districts of Khan Younis and Rafah.

Reaching a chosen site, the team unpacks drugs and supplies. Within minutes the site is converted to a health clinic. Patients arrive - it's a cross section of the community - and quietly begin to queue for services.

While they wait, patients tell me more stories. One explained her fear of going to the community clinic in an area were patrolling soldiers might fire on them.

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Moving toward the southeast, we stop at the remains of a kindergarten. Before the January war, the PMRS gave medical care to the children who attended this school. In the war, 288 children died, 1,606 were wounded and the school is a distressing sight for our PMRS partners.

A few families have built makeshift shelters here. A woman approaches and points to torn fragments of schoolbooks and even a page from the Qur'an half buried in the pulverized concrete and debris. She vividly communicates the story of the school bombing with hand and arm gestures.

As we move from one isolated village to another near Rafah, it's apparent that people here have no access to health care.

There are few cars or animal carts to carry sick patients. The nearest clinic is four or five miles away. Medication and services are unavailable; this can be a serious health risk for those with both acute and chronic health problems.

The mobile clinic team travels to about 20 marginalized communities like these in southern Gaza. Our team wants to maintain continuity of care for people living in an unpredictable environment.

In the coming weeks and months Merlin will support these vital services by providing a mobile health unit and help 5,000 families get the health care they need. It's a plan that holds great promise for all of us here in the field.

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