AMY GOODMAN: This is Democracy Now!, democracynow.org, The War and Peace Report. I’m Amy Goodman, with Juan González.

In Gaza, the healthcare system is barely functioning, eight months into Israel’s devastating assault. In a statement Monday, Gaza’s Health Ministry warned the few remaining hospitals still partially functioning could completely shut down if diesel generators needed for electricity are not replaced or maintained soon. The ministry said it expected a number of generators at hospitals to fail because Israel is preventing the entry of necessary spare parts. Health facilities that supply things like oxygen and refrigeration for medicine are facing a complete shutdown, which the Health Ministry said in a statement, quote, “means certain death for the sick and injured and the complete end of health services,” end-quote.

In addition to severe shortages of electricity, medical supplies and equipment as a result of the Israeli blockade, Gaza’s hospitals have been hit by Israeli airstrikes repeatedly over the last eight months. The World Health Organization said this week, since October 7th there have been more than 460 Israeli attacks on Gaza’s healthcare system, affecting over 100 health facilities.

More than 37,000 Palestinians have been killed in Israel’s war on Gaza, with thousands more missing under the rubble and presumed dead. A staggering 85,000 people have been wounded.

For more, we’re joined by Dr. James Smith, emergency medical doctor just back from Gaza, spent nearly two months there treating patients at trauma stabilization points in al-Mawasi and Rafah, also worked in the emergency rooms of Al-Aqsa Hospital in Deir al-Balah and Al-Awda Hospital in Nuseirat. He left Gaza Friday. He joins us today.

We welcome you to Democracy Now! If you can start off, Dr. Smith, by talking about the situation that you’re hearing from the doctors even in the few days since you have left, particularly after the attack on Nuseirat, which was considered the worst killing in six months, over 270 Palestinians killed this weekend, so many of them were brought to — so many others who were injured, it’s believed something like 700, brought to the hospital where you worked, to Al-Aqsa?

DR. JAMES SMITH: Thanks, Amy.

The situation in Gaza, and certainly in the middle area of Gaza, where I was working up until the 5th of June, remains catastrophic. The intensity of violence that Israel has meted out against the Palestinian people, the barbarity of it all, continues to — you know, you feel that you’ve seen the absolute worst, and the very next day it gets worse again. The massacre in Nuseirat on Saturday was certainly the worst of the violence that those neighborhoods have seen since the start of the genocide back in the beginning of October, 274 dead — killed, rather, as you’ve mentioned, approximately 700 injured. I would expect that in the coming days we will hear of more people who have died, who have succumbed to injuries that were sustained as a result of Israeli airstrikes and the Israeli ground incursion in that area, as a result of the collapsed healthcare system. As you mentioned, there are no fully functional hospitals any longer in Gaza and no health facilities that are able to absorb the sheer scale of need now.

JUAN GONZÁLEZ: And, Dr. Smith, your second trip now to Gaza, this one lasted nearly two months. Could you talk about how conditions changed over that period of time? Has there been any improvement in the arrival of supplies to these hospitals or the food situation? Give us a sense of what you saw.

DR. JAMES SMITH: So, to be absolutely clear, the situation deteriorates day on day. This is the sort of fallacy of humanitarian access, or the veneer of a humanitarian system. There is no improvement in any conditions in Gaza. This overfixation on the number of trucks that are entering into Gaza — or, rather, the number of trucks that the Israeli state has permitted to enter into Gaza — is a distraction from the violence and its many manifestations. We have almost the entire population of the Gaza Strip now forcibly displaced. The majority of those people no longer have homes to return to; entire cities — and I have seen them myself — Khan Younis, Gaza City, other neighborhoods, parts of Rafah now — that have been completely destroyed; homes, schools, clinics that have been vaporized to dust, concrete and sand. There has been absolutely no improvement in any of the basic conditions that are required to sustain human life in Gaza at the present time.

JUAN GONZÁLEZ: And how are you able to even administer, especially for those who require emergency surgery, of the wounded who come in? Talk to us about your direct experience with these kinds of — this kind of medical support.

DR. JAMES SMITH: Perhaps if I speak to you about my last day in Gaza at Al-Aqsa Hospital on the 5th of June. So, I was working in the emergency room that day. We had several electricity blackouts during that time. We were treating patients on the floor of the emergency room by torchlight. We had one young boy who came into the ER with an open femoral facture, bleeding profusely from his left upper leg, very, very severe injury. He had been injured as a result of an Israeli airstrike. The orthopedic surgeon, a junior doctor, very competent, but nevertheless still a junior doctor, came down to treat him, and without any anesthesia, because there wasn’t any, had to pull and splint his leg in order to stabilize him and to sustain his life long enough to get him into the OR.

The hospital now has five ORs, but you have a surgical team or several surgical teams that are working 24/7. There is no rest for the surgeons in these hospitals, and the scrub nurses working alongside them, phenomenally difficult conditions. We have an emergency team that are, frankly, the most dedicated doctors, nurses and allied health professionals that I have ever had the privilege of working with. But the conditions in which they are working were unsustainable eight months ago. Now it is just a testament to the sheer determination of the Palestinian people and the desire of Palestinian healthcare workers to administer care to the Palestinian people that these hospitals are able to function in any way whatsoever.

AMY GOODMAN: Dr. Smith, you’ve been talking about the effects of the bombing of people who survived and been brought into the hospital. What about the issue of hunger? UNICEF just came out with a report saying nine out of 10 children in the Gaza Strip are experiencing severe food shortages. If you can talk about what that means and how that affects them long-term, if they survive, and also the lack of clean water and drinking sewage water, leading to diseases like, for example, cholera?

DR. JAMES SMITH: So, hunger is rife across the Gaza Strip. There is a fixation of sorts among epidemiologists and distant public health experts in the terms of malnutrition. But hunger is rife. As I’ve mentioned already, Israel maintains complete control over what and who enters into and out of Gaza. They are able to manufacture the conditions of life — or, rather, of death in Gaza. And they have complete control over how much food aid or how much food enters into Gaza.

In my final weeks in Gaza, I was struck that commercial trucks from Israel were given precedence of access over the humanitarian aid trucks. So, in the south of Gaza, we saw several markets in which there were several fresh fruit and fresh vegetable commodities bearing the slogans of Israeli companies, but very limited food aid that was able to enter into Gaza. On several occasions, the big U.N. agencies said that they would have to stop food aid distributions. It was incredible to me that the very state that was starving people and inflicting such violence upon them was then bringing in food that, of course, people can’t afford to buy anymore, and that people, those who could, were having to pay for food from, as I say, the very state, the very economy that is trying to strangle the Palestinian people.

To your other point about access to clean water and sanitary conditions, the smell of sewage was rife throughout every camp that I passed through in Gaza, from Rafah to Khan Younis and into Gaza City, several instances of sewage overflowing onto the streets. In all of the locations I worked across Gaza and all of the hospitals I visited, including in the north of Gaza, in Gaza City, we saw patients who were suffering from very severe bouts of acute watery diarrhea, a major outbreak of hepatitis A, which is spread as a result of poor sanitary conditions. And, of course, all of those things together — hunger, lack of access to nutritious food, the impact of a lack of clean, drinkable water on physical health — is catastrophic. It will certainly have a major impact on all those people who are suffering as a result other health or trauma-related problems, as well.

AMY GOODMAN: Juan, we’re not able to hear you.

JUAN GONZÁLEZ: Dr. Smith, can you hear me?

AMY GOODMAN: Yes, we can.

JUAN GONZÁLEZ: Yeah.

DR. JAMES SMITH: Yes, I can hear you.

JUAN GONZÁLEZ: Yeah, you mentioned that you traveled all around the different parts of Gaza. Did you have any interactions at all with the Israeli Defense Forces? Did they enter into the hospitals? Or did you have any interactions with them at checkpoints?

DR. JAMES SMITH: We had to pass via the checkpoints that the Israelis have constructed, that have now severed across the north and south of Gaza from the east to the west. We interacted with the Israeli occupation forces during those movements. They were incredibly frightening experiences. During one of those convoy movements, one of the Palestinian drivers that was working for a U.N. agency was detained, stripped naked and taken away by the Israeli occupation forces. Very, very frightening, very unpleasant. And, yes, I saw and have heard stories of incredibly horrific encounters between the Israeli ground forces at those checkpoints and the Palestinian people, some of whom are still trying to move from north to south.

AMY GOODMAN: And finally, doctors who have died. We interviewed Dr. Hammam Alloh months ago, who was — when I asked him why he didn’t leave, as he talked about the intense bombing, he said he didn’t get his medical degree to desert his patients. He went home to help his family, and his house was bombed. You then have Dr. Adnan al-Bursh, head of orthopedics at Al-Shifa Hospital in Gaza City, who was arrested and died in an Israeli prison. As we wrap up, Dr. Smith, as you leave Gaza after two months, what about the doctors being imprisoned, doctors and nurses and staff being killed?

DR. JAMES SMITH: These are all the most egregious and horrific war crimes. And as I’ve mentioned, it was phenomenal to see the determination of my Palestinian colleagues, who will not abandon the Palestinian people or Palestine at this most horrific moment in their history. It’s tragic, beyond tragic, that so many Palestinian healthcare workers, that so many Palestinians have been killed during the course of this ongoing genocide. And it’s even more horrific that this violence is allowed to continue.

AMY GOODMAN: Dr. James Smith, we thank you for being with us. In 20 seconds, the U.N. Security Council has just passed a resolution put forward by the U.S. for a ceasefire. Hamas has just accepted. U.S. said Israel was accepting, though Netanyahu has said other things about that. Your message to the world?

DR. JAMES SMITH: I think I said this back in January when I spoke to you, Amy. The violence must end. And once the violence has ended, the real work of the pursuit of peace and justice for the Palestinian people must continue.

AMY GOODMAN: Dr. James Smith, emergency room doctor, just out of Gaza, spent nearly two months in Gaza treating patients at trauma stabilization points in al-Mawasi and Rafah, also worked in emergency rooms at Al-Aqsa Hospital and Al-Awda Hospital in Nuseirat. He was speaking to us from Istanbul, Turkey.

We’ll be joined next by a Jewish American Army major named Harrison Mann. He’s the first military and intelligence officer to publicly resign over President Biden’s support for Israel’s war on Gaza. Back in 20 seconds.