B (3:14)

And so did you work in, in the health service in Ireland first or did you immediately think I want to take these skills abroad or.

A (3:23)

No, I started off, I did a, I did a degree in physiology actually and then I did the conversion course, masters in Scotland. I think I went into physio thinking the classic I would have a little clinic, do outpatients, you know, back pain, neck pain. Turns out I really, really did not enjoy that setting at all once I was in it. And again surprised myself by finding that I was very geared towards intensive care, trauma orthopedics. And from there on I kind of geared my career towards humanitarian sector because I thought it was only volunteering at first. I didn't know I could get a career in it. So I did the training for the UK emergency medical team. It was a training specifically for occupational therapists and physiotherapists that we could be part of a medical team that gets deployed by the in response to say, an earthquake. So of course we had a lot of speakers who are specialists in burns and trauma, orthopedics and amputations. And that's the first time I twigged that you can have a full time career as a humanitarian physiotherapist. So that was when after about five, six years in the nhs I just handed in my notice and decided to go to Bangladesh for six months, work in a spinal cord rehab center and do. I helped out in university with teaching, but I also got some clinical work experience even at the Red Cross. That's how I got my CV in. And I also worked in Nepal for three months, again with spinal cord injuries. So it's a good way to explore whether you would like that work. It's a good kind of testing ground because if it doesn't work out you can just go back home essentially, you know, pick up your job again in the NHS and continue on and go, okay, that was nice, but no, I loved it.

B (5:04)

You've worked in a number of places. And I know you worked in North Korea, which I want to ask you about for a moment, but I'm always curious. I mean lots of people who have medical training think, oh, I'd like to take this abroad. But a lot of them excellent health professionals, but a lot of them have told me that when they first arrive in a place which is not Western high tech medicine, there's a lot of make do and mend work that they hadn't quite expected.

A (5:33)

Well, I think when I first went to Bangladesh, first of all I was weeping because I'd gone from Scottish climate to 30 degrees Bangladesh, 100 humidity. And I just remember frying under the shower at 3am Because I couldn't sleep because I was actively sweating. I had frogs in my room and ants and whatnot. The. So at first, yes, I was a bit taken aback and going, oh my God, this isn't the standard I would expect. But actually now, after a few years experience, actually when I look back on that, that center of rehabilitation of the paralyzed in Bangladesh, it was phenomenal actually out there. It set up, I would argue they might actually do better in terms that you have your whatever, three months stay there with spinal cord injuries and they have a little village built on the ground as well so that when it comes close to discharge, you and your family can have a practice run of living independently of the hospital. But during the day you can feedback saying, oh, we really struggled with toileting or with getting in and out of bed. And then they do practice sessions to help them adapt and then get them out where I think in many ways you're just kind of one Bam. Sorry. Send you home. Quick adaptation. Yeah, yeah, yeah. So. And they had a lot more adaptation. It was amazing actually, the rehab they could provide in that environment.

B (6:47)

And so you, you joined the icrc, you had a stint in North Korea. I don't know that many people who've been to North Korea.

A (6:53)

Tell me about that.

B (6:54)

What, what did you do? What was it like?

A (6:57)

That one took me by surprise. That was my first mission. So I had just, I was told I, I could be waiting months before I get my first mission deployment. So I kind of came back to Ireland and signed up for some locum work and I got this email of would you be willing to go to DPRK in two weeks time? I didn't know what DPKRK was. So yes, North Korea. And I went, of course, yes, I'm very curious about this life. It was quite a fascinating mission. I was there for one year, most of the work with the ICRC for a physiotherapist is working with prosthetics and orthotics. So we have many centers across the globe, really, that obviously do the pre prosthetic rehabilitation. And once we fit people with the devices that we help them and walk with them and that so that they're ready for discharge. So that's essentially what we were doing in North Korea. We had two centers, one that was within Pyongyang and one that was outside. And the one outside is more for civilians per se. One in Pyongyang was more military in their family. Very interesting. I mean, mostly amputees, for sure. They were quite vague about how they got their amputations. They were a little bit evasive, but more often than not, it was just fractures gone wrong. It was infections. One person lost his leg from a shark. Frostbite was a big one because it gets down to minus 30 degrees. I had a pair of twins who had lost both their legs because they got lost during the winter and they weren't found for a month. So it's a miracle they survive. But I would say the North Koreans, for sure, very hardy people do not complain. They were just like, yep, we're ready to go. Yeah, the device is good. You're bleeding. We need to adjust this. Like you're getting wounds. No, no, no. I'm good to go. I'm good to go. Not demanding at all. And. And lovely, actually. Something really nice. And one. One lady was a carer for her granddaughter who'd lost her leg in a burn, and she would then cook us treats, and then I would return the favor by baking them a cake. And then she would return the favor by baking for my whole office. It just became this little competition who could give more. They were just really, really generous. Really nice. Yeah. I was very surprised by what I found there.

B (9:04)

Maybe because it's such an unknown land, we have too many preconceptions about what it might be.

A (9:09)

It is a little bit like the Truman Show. I mean, everything is very often things for show. They like things to be. Look big and grand, and they're a bit elusive about any negative things in their. In their country, for sure. But, you know, it was very interesting. They have a burger Kim. Aha.

B (9:26)

Not Burger King. Burger Kim.

A (9:28)

Burger Kim. Kim. Fried chicken. There's all these little things that are slight variations of what you would see in Europe. It was quite a privilege to have gone for a foreigner. I was surprised by how much freedoms I had because I was allowed to walk around the city. In fact, I drove. I have a North Korean driver's license. It expired after two years. But I had to do the test with the military, which was very interesting in itself because they drive for me on the wrong side of the road and they failed me on the first attempt because they said I slowed down for pedestrians on the road, which I thought that was a bit funny. So it was. It was, in many regards, quite an entertaining mission in terms of what you could see that nobody else could see. But also, I really loved my. My colleagues. My Korean colleagues were really nice and fun to work with. The patients were really lovely. And that's the side that doesn't really get shown, I think, in the media often enough, because, again, journalists can't really go in and report. But no, yeah, I would. I would go back. Sure.

B (10:24)

Let's move on to where you've been most recently, then another place foreign journalists can't go in and report, and that is Gaza. You've done a number of stints there since October 7th. I'm just wondering again what your first impressions were compared to perhaps what you were expecting.

A (10:45)

To be fair, I think what's shown on the media really does prepare you. I mean, I don't think it's a secret. I know there aren't journalists, but everyone's posting about us. I mean, my feed is full of it. So actually just really affirmed what I was seeing online is actually true. It's just the fact that things are complete rubble. The first time I went into Gaza, it was last year and it was just a few weeks after the Rafah border had been shut. So at that stage, Rafah was still relatively intact. But now it's. Now it's completely flat, it's complete rubble. I was working in Khan Yunus at the time in European Gaza Hospital, so I actually didn't see much outside of that life. But it was a. It was basically an IDP camp. We had thousands of people living on the grounds of the hospital because they thought it was the safest place to be. But that meant you had people cooking on the wards, in the corridors, you were stepping over their families or extended families trying to get to the patients. So that took me a little bit aback because I wasn't realizing how much the IDP camp would affect actually work inside the hospital. Now, I did then return to the Rafah field hospital then in March. And again, I have interesting timing. I came just two days after the ceasefire ended rather abruptly. So I've never really seen a cease firing as I've never really experienced any sort of lull. I only know it to a backdrop of explosions and gunfire which is pretty much continuous throughout your days of work. I mean, more bombs than birdsong for sure.

B (12:14)

Tell me a bit about your patients. Maybe one or two that stand out to you because you are, you are a physiotherapist and you know, here in peaceful country like Ireland or Switzerland, physio we think of as, you know, maybe if you've got a bad back or you've, you've had a broken arm or leg or these are probably not the kind of injuries you're dealing with.

A (12:35)

No, if you, if you're working in a trauma ortho ward in the uk, for example, you might have someone in a, in a traffic accident or if someone had fallen from a height and he might have a fractured arm, maybe a fractured leg with it. But in a conflict zone, the wounds are very, very different. They're mostly open wounds and by that I mean penetrative injuries. So you're looking at shrapnel or you're looking at a bullet wound. So just through that you already have a different injury. You've got the fracture which is much more severe because it's a very high velocity object which has caused it and has splintered the bone. You might also have bone loss, which means you might end up getting your limbs shortened. There's actually a higher risk that your limb needs to be amputated because of the open wound. That means your vascular system is compromised. If you don't need any of those severe shortenings or removal of your limb, you've got also the issue of infection. So there's just a lot more difficulties surrounding the injury that you have more often than not. It's not just one limb either. I had one man, Ahmed. I mean, he was a miracle really that he managed to survive. And he was phenomenal young man. He was 19. Shrapnel injuries. He had fracture in his left hand. He needed wires put in and a cast. He had fractures on his right forearm. He had such a severe open wound in his right leg. Bone loss. His leg had to be shortened by 10 cm. He has an external fixator on his head was fine and his left leg was fine. His abdomen had been shredded as well. He's a stoma bag in it. You know, the 19 year old who was hoping to be an engineering student, Kurdistan, that was his, that was his ambitions. But yeah, just trying to get on top of his medical care and then his rehabilitation care. When you've only Got one leg to work with. You've got maybe four wheelchairs in a whole hospital so that you can encourage his brother to get him out in a wheelchair so he gets off the bed. He can't really use any of your walking aids because crutches require hands and both of his arms are fractured, his forearms. We would have these devices in the UK that you could use to be like a large frame that you can rest your elbows on. Don't have that. We've, we've got three basic walkers in the whole hospital for at that time, 60 beds and now we've 120 patients. So even harder to share any walking aids.

B (14:47)

So was the ICRC asking to get more of these mobility aids in?

A (14:52)

We had an order, unfortunately. We used to keep a lot of our stock in European Gaza Hospital, but it was evacuated last year, so a lot of our stock was looted. Wheelchairs and walking frames. We did have an order in since November 2023, but it never came. It was kept in Jordan. To my knowledge. We don't get much information of why it can't come in or if there's a particular item in the lorry that they don't like. You're just not told, you're just told no and you just know it's sitting there waiting. So we had crutches waiting, we had frames waiting, wheelchairs waiting, but we didn't have them. I mean, we've got shortages everywhere of like medications and surgical implements, everything. But just imagine also what you're discharging them home to. So at least in the uk, you know, you're unlikely to have lost your home, really. You have a house, you know, you have a bed, you have a bathroom. Maybe you need some adjustments to those items and you can get occupational therapy. We'll put in bed rails and a special toilet seat. I'll give you a commode. What we're discharging people to now is tents. They're sleeping on the ground. It's very, very complicated for someone with a spinal injury to get off the ground and mobilizing with a walking frame if they had one. But you don't have a walking frame, you don't have a wheelchair and you don't have a raised bed. You're in a tent and you might be sharing it with 20 relatives. You might still have wounds that you need follow up care for. Good luck trying to keep them clean. Like we've got really high infection rates because people can't wash themselves. Soap is very hard to find, so it's Just all around compounding issues make really difficult for anyone to fully heal from any of their injuries.

B (16:24)

You also, you gave an interview actually to the ICRC online website about voices of ICRC workers, where you said you went knowing what, what you might expect in Gaza, but you hadn't expected to be working in casualty with people immediately wounded.

A (16:41)

I think what you were referencing to is the fact that I was stopping bleeding rather than rehabilitating and that was largely because we had such an influx of mass casualties that we just couldn't cope with the staffing we had. So my initial six weeks, it was fine. We were 60 bedded hospital. We did have mass casualty incidents, but they were usually about 40 people coming in in a short period of time and we could absorb that. We were fine. When I came back for the second round of six weeks, this was just as the food distribution centers opened in Rafah and I can't come back to who responsible for all the gunfire. However, people were being shot going to or at or leaving these food distribution centers and that was sending waves and waves of casualties our way. But like, in numbers we never would have anticipated. So we were looking at 181 day, 60, the next day 174. 244 was the highest we had and you just couldn't recover from that. So imagine how you've got the staffing, usual staffing for a 60 bedded field hospital. Imagine now also it's the night shift, so you've got reduced staffing and obviously there's no surgical team because we, at that time we weren't doing surgeries overnight. So the mass casualties in the beginning were. Because the food distribution centres would open at approximately 7am, the mass casualty incidents would usually start around 4,35,30. So it was right in the middle of the night shift. So honestly, when you've got 100 people in a very short period of time coming in, you don't have enough staff and it is really all hands on deck. And that's how I found myself, patching up more bleeding than I would have expected and helping out with tourniquets.

B (18:20)

Do you ever get depressed or angry? I mean, you seem so cheerful and motivated, but when you see that you're talking about hundreds of people shot coming in in waves. Do you ever get depressed or even angry?

A (18:32)

I don't think depressed and angry would be the right word for it. I. I guess I got my work hat on so I know I can do something about it. You ever have that helplessness when you see someone injured and you don't know what to do. I always admired when there was somebody on the scene who, like a paramedic who knew exactly what to do, knew how to react, knew how to respond, give the best care. But, like, over the years, I have become that person in terms of physiotherapy, and I've also done a lot of trauma first aid through my work, so I know what to do. And I suppose I'm happy that I. I can do something of help, because you really just want to help all your nursing and doctor colleagues at this stage and all your physio colleagues. You want to be an extra pair of hands so you don't really have time to be depressed and upset. I had moments, of course, when I would have to take a breather and go in my tents, have to take a deep breath, and then go back at it. Because what I found very overwhelming was the screaming and the bleeding. It was. It's not just the injured. It's all the families that come with them, and it's like chaos. People are lying on the ground. I mean, they see you and they think you're a doctor and they're trying to pull you over. They're weeping. You go and check on a person lying on the ground, you realize they're no longer alive. Then you just try and go and treat someone that you know what you can do with. You know, he's got some chest wounds or you've got some leg wounds. I'm like, okay, I can patch that up. I can help apply a tourniquet for sure. I can try and stabilize this fracture. That's actually the main role I'm supposed to have in the ED Department needs to stabilize fractures. So, yeah, I think you don't really have much time to process what is happening other than, oh, God, let's just get through this wave and hope it calms down and we can catch our breath and really, really try and deliver the best care.

B (20:13)

And what about when you get home, when you've got more time to think about it?

A (20:17)

I'm. I'm okay. I. I think I'm. My frustration at home is that I'm not there helping. I think I know it continues after I leave. I think that's what I find hardest. It's not reliving the mass casually instance. It's getting through the border and leaving people behind. And I'm still in touch with them, and I can see the news. And then I worry, of course, that things are worse, and then I'm not there helping. And Then I feel guilty. That's what I wrestle with the most, I think it's not being there.

B (20:47)

So you'll go back, I guess?

A (20:49)

Yeah, yeah, yeah. The organization is aware that I'm ready to go back and when I'm ready to go back, so.

B (20:55)

For sure, yeah, I guess you hope the situation is different the next time you go.

A (21:00)

It always is. And unfortunately, it's always worse. I mean, March was worse than when I was there last year in May. June was by far the worst I had experienced with daily mass casualties. Things were a bit safer, I'd say. Less free bullets in the hospital now, when I was there just last week. But the situation in Gaza has gotten worse, of course, now with the evacuation of Gaza City. So that's, of course, sending more and more people south to Al Mawasi and towards Khan Younis, really. And that also isn't safe. I mean, people are already struggling for housing there and for clean water and for food. I think now there's an additional 350,000 people who've now evacuated there. Like, where are they going to stay?

B (21:42)

Somebody like your patients, the young man you talk, whose arms have been fractured, his leg has been shortened. And there are many people with these kinds of injuries. How can they even move to a new place like that?

A (21:55)

They rely wholly on their family members to carry them. And that's the grim reality of it. We don't have wheelchairs to offer. And the few wheelchairs that we do have or did have, they were very much reserved for people with complete spinal cord injuries or bilateral lower limb amputation. So, yeah, they are fully dependent for a time. I mean, this, this fellow, Ahmed, I did meet him actually, two weeks ago. It was the first time I'd seen him in months. And, yeah, he's walking. He' got his crutches, the crutches that we made out of pallets, of course, or wooden crutches. You can see him limping because he's got the leg length shortening. He got his colonoscopy reversed, so now he's got his abdomen closed finally. What I was really happy to see was his brother, Muhammad. Actually, Muhammad was his carer in the. In the hospital for many months and he was also one of the victims in the mass casualties. So last time I had seen him, he was lying on the floor and he'd been shot in the neck and in the left shoulder. So I didn't know if he'd survived or not. So to see him walking alongside his brother, the two walking wounded, was quite a relief. Actually. But, yeah, they are very dependent on friends, family, if they have any left, of course.

B (23:02)

One final question then. Rika, you told us how happy you were to see that patient Ahmed and that his brother also up on his feet again. Is that the moment? Moments like that, think, yeah, I've definitely chosen the right job.

A (23:17)

Yeah, for sure, for sure. Yeah. And. And there's many stories like that where, you know, you've put them on the path to being independent and being more capable of surviving this. But, I mean, I don't want to. Again, I'm going back on a downer. But you're also sending them back out and you're hoping they survive the war. So I don't know many, many patients that leave our hospital that I say, we did a good job, we've done the best we can. I don't know if they are still alive, if they're still walking, but we do what we can. And I will say this for the staff in the Rafflefield Hospital, and I'm not just talking about the international staff, I'm talking about the Palestinians. They are incredible. They are really talented, really, really good carers, very passionate. Obviously it affects them deeply. It's their neighbors, it's their friends and families and they just do a phenomenal job. And I honestly, I don't know how they have the capacity to do it because I, I do my six weeks and I know I'm going to leave and I can relax a little bit and sleep. I don't need to worry about my families while I'm working. But they, they have their families to be worried about. They are all living in tents and yet day after day they come into work and they still do an incredible job and they're really motivated. They're just such lovely people to work with and playful and generous. The little food that they have, they're sharing with you and they banter with you. And I'm impressed that they can still have a sense of humor despite everything that goes on. They really are astounding to work with, a real privilege.

B (24:46)

And that brings us to the end of this edition of Inside Geneva. Huge thanks to Rika Hayes for sharing her experiences and her precious free time with us. We hope you enjoyed listening to her. Next time we're going to hear from Russian Russia writers and journalists who traveled to Geneva to warn the UN Human Rights Council about the growing crackdown on freedom of expression. And not just in Russia. Russia is now run through a state sponsored system of fear and punishment, where dissent is erased and civic space dismantled.

A (25:29)

Just be aware of this danger.

B (25:32)

Just don't let it happen. Don't think that, okay, it's nothing.

A (25:36)

It's just they closed down this program or whatever. We have so many other problems.

B (25:42)

So I'm watching now closely what's happening in the United States with closing of these programs. How is the society going to react?

A (25:49)

What will happen?

B (25:51)

Because this is how it starts.

A (25:55)

It's never late to acknowledge how precious democracy, how precious freedom is.

B (26:00)

You know, it's been more than a.

A (26:01)

Year since I got released from prison. Every morning I open my eyes, I'm so thankful. I know democracy and press freedom sounds very vague for people who live ordinary lives, but actually, when it comes to you, to your door and rings your bell, it's too late.

B (26:23)

Join us on October 14th for that. In the meantime, you can catch up on previous episodes of Inside Geneva. Wherever you get your podcasts, find out what the laws on genocide really say, or how the International Red Cross unites prisoners of war with their families, or about the impact on women and girls of the cuts in humanitarian funding. Don't forget to subscribe to us and review us. We're always keen to hear your views. I'm Imogen folks. Inside Geneva is a Swiss info production. Thanks again for listening. Hello, this is Imogen folks from swissinfo's Inside Geneva podcast. This summer, like last year, we're bringing you a fascinating series of summer profiles, starting with doctor, aid worker and now journalist Tamam Aloudat. Can we afford to only put roofs over people's heads and do nothing about the system? If your house was bombed for the first time, I understand. If it was bombed for the 17th time and instead of a house you have a tarp and instead of food you have animal feed or grass to eat. Then later this month we'll hear from international lawyer and candidate to be judge on the International Court of Justice, Dapa Wakande. It's clearly the case that in far too many cases international law is disregarded and you only have to turn on.

A (28:02)

The news to see that.

B (28:03)

What I do know is that actually.

A (28:05)

International law is increasingly regarded as relevant.

B (28:09)

From now till September. We've got got all sorts of amazing people to talk to, from an aid worker in Gaza right now to someone who started his career in Gaza 40 years ago. Join us on Inside Geneva wherever you get your podcasts.