My hospital, the main institution serving southern Israel, has come under rocket fire since the very first day of the war. As a result, there have been far reaching changes in its functioning. Extra staff: doctors, nurses and orderlies have been added to the emergency room on every shift. All leave has been cancelled.
The surgical service has been most affected. More than half of elective operations have been cancelled in order to keep hospital beds and ORs available to look after any and all casualties – both civilian and military. The activity of our helicopter pad which is right in the middle of the hospital campus allows us to know when there are “incoming wounded.” A team of doctors and nurses is always waiting on the ground for the moment that the helicopter touches down. Unfortunately, this scene is one which I have witnessed for years, since this assault by Hamas on southern Israel did not begin with the advent of our recent response. It has been going on for years. However, the rate of landings has increased dramatically. A bit like “M*A*S*H” but without the laughs. 
There have been other effects on the hospital’s functioning. For example, we are a 1100 bed teaching institution located on a large campus. There are a couple of six storey towers and a number of outlying smaller buildings. These include my own Department of Geriatrics which was located in a one storey building. On the second day of the war we got a call from the Home Front Command which had decided to close us down. Our department is in a one storey building and would not be able to withstand a direct hit.
Within six hours we were to discharge as many of our 25 patients as possible – either home or to surrounding nursing homes. Those patients too sick to be moved were transferred en bloc together with our staff into a more secure building on the third floor of one of the towers. We function with half of our patients and just under half of the staff. Those not working on our “mini-ward” have been sent to the ER or other wards.
During this exodus there were three alarms in the Beer-sheva area. It is hard to describe the fear and anxiety of these frail patients and their families as we tried desperately in the 45 seconds (sometimes) given to us by the alarm to move patients into the relative safety of the halls. We did a pretty good job and fortunately for us the rockets struck elsewhere.
While I am still allowed to use my office, it is not only weird to sit here alone, it is also sometimes quite frightening. For example, just yesterday the alarm went off and I ran into the hall, crouching in the “safe” area which would have done me no good in the case of a direct hit. Several seconds later I heard and felt a tremendous crash as a Grad rocket landed just 100 metres from the hospital.
I was lucky this time.
Dr A Mark Clarfield, a long-time contributor to Medical Post, is a doctor at the Soroka Hospital, Beer-sheva, which serves the south of Israel.