What the wounds are telling us

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It is swelteringly hot as American doctor Feroze Sidhwa walks into the intensive care unit of the European Hospital in Gaza. On the hospital grounds, the air smells of sewage and spent explosives. Inside it smells like rot. And dead bodies.

Sidhwa is a 43-year-old trauma surgeon and critical care physician from California, based at a hospital in Stockton. Among colleagues, he’s held in high regard — not just for his clinical expertise, but also for his international work. He never takes more than a week off, unless it’s for a humanitarian mission. He has worked in crisis zones like Zimbabwe and Haiti, and trained surgeons in Ukraine and Burkina Faso. He wants to go where he’s needed most.

It is March 2024, and this is his first day. A Palestinian nurse is guiding him through the hospital. Then, suddenly, his gaze lands on two young boys lying utterly still in their beds. They look no older than eight or ten, he estimates. Their heads are swathed in bandages. They are on ventilators. The rest of their bodies are intact.

“What happened?,” he asks.

The nurse barely speaks English. But she points to their heads. “Shot, shot,” she says.

At first, Sidhwa assumes she’s mistaken. Are they shooting at children? Minutes later, looking at the scans, he sees she was right.

When they step into a second room, they find two more boys, in the same condition.

“I thought: what the hell?” he says over the phone to de Volkskrant, his deep voice steady. “How is it possible that, in this small hospital, four children are lying here with gunshot wounds to the head — all admitted within the past 48 hours?”

The four boys are all slowly dying. That evening, Sidhwa makes a note in the diary on his phone. But there’s no time to reflect. Not yet.

In the thirteen days that follow, he sees nine more children with single gunshot wounds to the head or chest — children who were likely shot deliberately. “I started to wonder if my hospital was near some crazy sniper,” Sidhwa says. “Or a drone team killing children just for fun.”

Back home, at a medical conference, Sidhwa meets an American colleague who had worked in another hospital in Gaza just before him. When Sidhwa brings up the children, the man nods. “To my surprise, he said: ‘Yeah, I saw that too — almost every day.’’”

The doctor in question, Thaer Ahmad, confirmed this account to de Volkskrant.

“That was the moment,” Sidhwa says, “when I decided: I have to find out what’s really happening here.”

The last witnesses

Feroze Sidhwa is not the only doctor who, after returning from Gaza, feels compelled to speak out.

For nearly two years, physicians like him have borne witness, from their operating rooms, to the brutality of Israel’s assault on Gaza. They have learned how to hold dying toddlers as they choke on their own blood — because there is no ventilator. They have found the strength to drive a scalpel into a teenager’s chest without anaesthesia — because there is no time, and another patient is already waiting. They have adapted to keep moving as the floor beneath them fills with the bodies of children.

Some doctors have been left numb. But others have chosen to speak out.

These physicians are among the last international eyewitnesses, as Israel does not allow foreign journalists into Gaza.

They can speak from first-hand experience about the consequences of the genocidal violence, which, with the levelling of Gaza City, has entered its next pitch-black phase.

That role comes with a heavy dilemma. Nearly all of them want to return to Gaza. But going public with what they’ve seen increases the risk that Israel will deny them reentry. According to the United Nations, more than one hundred foreign medical workers have been turned away since March 2025 — often without any official explanation.

Many doctors have come to accept this threat. Being silent is not an option.

Over the past few months, de Volkskrant spoke with seventeen doctors and one nurse from the United States, the United Kingdom, Australia, Canada, and the Netherlands. Since October 2023, they have worked in six hospitals and four clinics across Gaza, often returning once or even twice. Most of them have extensive experience working in crisis zones such as Sudan, Afghanistan, Syria, Bosnia and Herzegovina, Rwanda, and Ukraine.

At the paper’s request, they handed over hundreds of photos and videos of patients, X-rays, medical notes, and diary entries. They talked for hours. They laid bare what they saw in their operating rooms. And they all faced the same question: what are the wounds telling us about the war?

An absolute hell

British transplant surgeon and professor Nizam Mamode, 63, was already semi-retired when, in the summer of 2024, he received a call from the aid organisation Medical Aid for Palestinians. They asked if he could go to Gaza in August. “I had the time, and I knew I had the skills,” Mamode says. “I’d worked in Rwanda, Sudan, Lebanon — so I said yes. Some people say it was a brave decision, but it wasn’t. To be honest, I had no idea what I was getting myself into.”

It wasn’t until he was riding through Gaza in armoured vehicles with more than thirty others from the UN convoy that reality kicked in. “The doors were locked,” he says. “We were instructed: when you set off, do not unlock them — if the Israeli army shoots at you and orders you out, do not get out of the vehicle.”

“Try not to get killed,” the convoy leader told them.

“Two weeks later, the same vehicles were fired upon by Israel,” says Mamode.

Just before that, at a checkpoint, their luggage was searched by men in black uniforms. In Gaza, there is a shortage of nearly all medical supplies. That’s why doctors bring basic items with them. But often, everything is taken away — even baby formula. It has happened on multiple missions, the doctors told de Volkskrant.

The British plastic surgeon Sarmad Tamimi, who crossed into Gaza on June 24 this year, had already been warned by colleagues about confiscations. But he was also aware of the starvation in Gaza and the devastating consequences for babies. “I took baby nutritional supplements out of their boxes and packed only the foil in my luggage,” he says. “To the soldiers, I said I was taking them for myself.”

American emergency physician Mimi Syed managed to smuggle two laryngoscopes under her clothes—indispensable tools for intubating patients. “I was scared,” she admits. “But as a doctor, I need them to save lives. Normally, you throw a laryngoscope away after one use. In Gaza, I used it on at least fifty patients. I had to wipe it and use it again in different patients.”

“I don’t understand why baby food is confiscated from doctors crossing the border,” says British plastic surgeon Victoria Rose. “I don’t understand why doctors’ medicines are taken away. I don’t understand why half of the doctors are denied entry. There are so many things I don’t understand.”

In a response, the IDF stated the claims about baby formula being confiscated are “entirely incorrect.” The military stated that it was, in fact, working to facilitate the entry of humanitarian aid. According to the IDF, since May 19, 2025, “approximately 5,000 tons of infant formula alone have been transferred into the Gaza Strip, in addition to extensive quantities of other humanitarian aid.”

The doctors interviewed by de Volkskrant worked throughout the war in various hospitals and field clinics, including Nasser, Al-Aqsa, the European Hospital, and Al-Shifa. Some worked with Médecins Sans Frontières and with organisations that asked not to be named, fearing that identification might prevent them from continuing their work. They include general surgeons, orthopaedic surgeons, intensivists, plastic surgeons, trauma surgeons, and emergency physicians. A few were still in Gaza at the time of the interviews. The newspaper also spoke with a trauma nurse with war experience.

The situation in Gaza’s hospitals, many of which have been largely destroyed, is far worse than the doctors had anticipated. “I had to cut off a woman’s leg with scissors,” says emergency physician Syed. “Without pain medication. I had no other choice.”

The wards are heavy with the smell of burnt limbs. “We constantly heard people screaming,” recalls Rotterdam doctor Salih el Saddy. “In our hospital, we had anaesthetics, but no painkillers. Patients woke up after amputations with extreme pain. There was nothing we could do for them.”

In the operating rooms, staff are busy keeping flies away from patients who have been cut open. Nizam Mamode watches as a fellow doctor in the intensive care unit tends to a child whose ventilator is not working properly. When he removes the tube from the child’s throat, he sees it’s clogged. “Full of maggots,” says Mamode, “coming from the child’s throat.”

The MRI and dialysis machines, doctors say, are beyond use—riddled with bullet holes. Some operating rooms have been set ablaze. The cables of ultrasound machines have been cut.

There’s little time for reflection. Yet at times, without warning, a sense of disbelief creeps in. Mamode experienced this while operating on an 8-year-old girl. “She was bleeding out, so I asked for an abdominal gauze swab to soak up the excess blood and locate the wound,” he recalls.

He was told there was no gauze.

“Suddenly, I thought about the irony of it,” he says. “The word ‘gauze’ supposedly comes from Gaza, because Gazans were famous for their linen. So there we were, in the home of gauze — and I couldn’t get any. I had to scoop the blood out of her body with my hands.”

Emergency physician Adil Husain recorded a video message for his young daughter before his departure, in case they would never see him again. Others arranged their wills. All the doctors interviewed by de Volkskrant felt a strong intrinsic urge to go.

“I’m a surgeon. I want to go where the need is greatest,” says a doctor who will soon return to Gaza and prefers to remain anonymous out of fear of repercussions from Israel. “My work there matters. It’s a signal to the people in Gaza: we have not forgotten you.”

International doctors usually stay in Gaza for two to six weeks—then they are rotated out. Many of them sleep in the hospital and barely leave it for weeks on end. At Nasser Hospital, around fifteen surgeons share a room on the fourth floor, close to the operating theatres. At night, the heat can climb to a 100 degrees.

Surgeon Nizam Mamode sought relief on the stone staircase next to the ward. “I slept on those stairs every night, hoping it would be safe from the drones,” he says. Last month, he witnessed the upper part of that same staircase being destroyed by an Israeli strike — an attack that drew international attention because there was video footage capturing the moment when aid workers and journalists were killed.

The vast majority of injuries come from bomb and shell explosions: people are hit by the blast waves, the heat, flying shrapnel, and collapsing buildings. Shards tear straight through tents. And through the bodies of countless children—who make up more than forty percent of Gaza’s population.

“I’ve seen numerous children with brain matter hanging out,” says MSF-nurse Jack Latour. “I’m sorry—I know no one wants to hear that. But that is what’s happening here.”

The first time surgeon Goher Rahbour found himself in a mass casualty event, he saw a five-year-old girl without a foot. “It was on the floor. The child next to her was also just a kid. Her leg was gone from the knee. Then came another. I froze. I thought: this is absolute hell.”

According to Gaza’s health authorities, more than 64,000 Gazans have died so far, including nearly 20,000 children. Israel questions the reliability of these figures, arguing that the ministry is controlled by Hamas. A group of international researchers concluded in the medical journal The Lancet that the figures from that ministry actually represent an underestimation

Of all the patients, there is one group that shocks doctors most: children with gunshot wounds to the head or chest — and bodies otherwise untouched.

A single bullet to these areas is a strong indication that the child was deliberately targeted. That constitutes a war crime. In other conflict zones, the doctors rarely encountered such cases.

On August 14, 2024, doctor Mimi Syed writes in her journal. The sentences are short. Staccato.

14 August 2024

Girl, 7 years old. Gunshot wound to the chest. Dead on arrival. Tried to save her. Part of a larger mass casualty incident. On the floor, no cots. Nearly slipped in blood. Can’t eat for two days. Can’t swallow anything. Will I be normal again?

Dr. Mimi Syed

Syed is an American emergency physician who spent two four-week rotations in Gaza, working at Nasser Hospital in Khan Younis and Al Aqsa in Deir al-Balah. “Like most people, I was following the war through livestreams on my phone,” she says. “But I couldn’t do it anymore. I’m a mother. I couldn’t just watch and do nothing.”

She describes Mira, a 4-year-old girl she saw at Nasser. Her parents bring her in. “They said she’d been shot by a quadcopter [armed drone, ed.] while walking around in the humanitarian zone declared by Israel. I was told to just let her die by my colleagues. The assessment was, unfortunately, that there wasn’t much we could do. But she was still moving a little bit. She was very young. A little girl. I just couldn’t look away. There was something in her face that struck me. So I took a chance.”

Syed intubates the girl using the laryngoscope she had smuggled in herself. Moments later, she stared in disbelief at the scan of Mira’s head: there’s a bullet lodged inside.

With the help of her colleagues, Syed manages to keep Mira alive. Later, the little girl will wake up and begin to speak again—a small miracle. Much later, another doctor will remove the bullet from her head.

But Mira is not the only child with a bullet in the head that Syed encounters. She decides to take pictures of them. “I thought: I have to document this. I realised—these are war crimes.” Under extremely stressful conditions, she photographs eighteen children who had been shot in the head or chest. All of them were single shots, she says.

De Volkskrant asked doctors how many children aged 15 and under they had seen with a single gunshot wound to the head and/or chest. The question was deliberately limited to this age group, as children of that age are, in most cases, visibly and unmistakably children.

Fifteen out of seventeen doctors said they had encountered children aged 15 or younger with such gunshot wounds. Taken together, they reported 114 children—many of whom did not survive.

Some doctors took photos or made notes; others relied on memory. At the newspaper’s request, they gave the most conservative possible estimates: any cases they were unsure about were excluded. Children who had also been shot in other parts of the body were not included in the count either, as such injuries offer less certainty of deliberate targeting.

The doctors suspect that the total number of children shot in the head or chest is many times higher than the number they personally witnessed. Children who died instantly, they say, often never made it to their departments. Moreover, the doctors were not working in all of Gaza’s hospitals — and only for a limited period of time.

At the newspaper’s request, doctors provided self-taken photos and videos as evidence. In total, de Volkskrant reviewed images of dozens of children with gunshot wounds to the head or chest. The majority of these images will not be published, as they are too graphic.

De Volkskrant presented dozens of images of children with gunshot wounds and various X-rays to two forensic pathologists. They confirmed that the injuries were caused by bullets, not by flying shrapnel.

“It is highly likely that these are long-distance shots aimed at the head and/or neck using military-grade ammunition,” says forensic pathologist Wim Van de Voorde, emeritus professor at the University of Leuven. According to Van de Voorde, the photos are not of sufficient quality to draw legal conclusions — “which is understandable, given the extremely difficult local circumstances.”

Forensic pathologist Frank van de Goot says: “On the X-ray images, I see children’s heads with bullets lodged inside. The bullets must have lost a lot of energy along the way, because children have thinner skulls than adults — otherwise, the bullets would have gone straight through. So these children were shot from a considerable distance.”

That finding is consistent with eyewitness accounts, in which civilians told doctors that the bullets were usually fired by armed drones or snipers of the Israeli military (IDF). Snipers are capable of targeting specific individuals from long distances — sometimes over a thousand meters away. The IDF declined to answer questions about snipers shooting at children.

According to former commander of the Dutch Army, Mart de Kruif, the likelihood that these are accidental hits is virtually zero, given that the doctors describe more than a hundred such cases. “Just think about how small the head is compared to the rest of the body,” he says. “If you’re seeing a high number of gunshot wounds to the chest area and the head, that’s not collateral damage — that’s deliberate targeting.”

Israeli Prime Minister Netanyahu and the military leadership have consistently denied that soldiers deliberately shoot at Palestinian civilians. However, anonymous soldiers have repeatedly admitted in the Israeli newspaper Haaretz that this does happen. Breaking the Silence, an Israeli organisation of military veterans, also revealed—based on hundreds of interviews with soldiers—that they were ordered to shoot anyone entering a certain area. “Adult, male — kill,” says a captain in the investigative report The Perimeter.

Israeli Prime Minister Netanyahu and the military leadership have consistently denied that soldiers are deliberately targeting Palestinian civilians. But anonymous soldiers have repeatedly admitted otherwise in the Israeli newspaper Haaretz.

In August, the BBC published the findings of an investigation into more than 160 children who were shot in Gaza. In 95 of those cases, the bullet struck the head or chest. The BBC spoke with eyewitnesses in 59 instances. In 57 of them, the shot was attributed to the Israeli military. In just two cases, the bullet was said to have come from Palestinian fire.

Most of the doctors interviewed by de Volkskrant said they wished they had gathered more evidence afterward, but in the chaos of Gaza this simply wasn’t possible. Or they didn’t dare to try. Orthopaedic surgeon Mark Perlmutter (69), who has carried out forty humanitarian missions, said: “I wish I had had the presence of mind to document more.”

“This is my biggest regret,” adds American anaesthesiologist and intensivist Ahlia Kattan. “But I was treating patients. At that moment, it simply wasn’t at the top of my mind. I wish someone had told me beforehand that I should not only act as a doctor, but also as a journalist.”

“Beforehand, the NGOs told us: don’t document anything, don’t take notes, don’t take photos,” says Feroze Sidhwa. “They’re terrified that Israel will then bar them from entering Gaza.”

But their memories of the children are sometimes remarkably detailed.

“During a mass casualty incident, I was walking through the emergency department,” Perlmutter recalls. “Children were everywhere. I was turning them over, trying to see who I could still help. And then I saw those two little boys. They were dead. They had both been shot—through the chest and the head. Six or seven years old. I examined them. I asked the medical assistant to take photos.” The photos are in possession of this newspaper.

Perlmutter remembers hearing the man who brought in one of the boys screaming. “He couldn’t understand why a shooter had hit this child—and not him, the adult.” Moments later, he sees the man, probably the father of the child, sobbing. The man sits in shock on the floor, while the child is taken to the morgue. Perlmutter takes out his iPhone and snaps a photo.

Anaesthesiologist and intensivist Ahlia Kattan tells the story of a small girl brought in by her mother:

“She was not even two years old,” she says. “She was very pale, and she looked perfect, so I assumed she had an internal bleeding.

“She was dead. But her mother was screaming—heartbreaking cries. She had spent years and years trying to have a child. So we started CPR, and I intubated her. I wanted to show the mother that I had done everything I could. We often do that with very young children. While I was working on her, someone handed me the scan. And then I saw it: a bullet in her head. I saw the blood. A perfect shot to the temple.”

“I took a photo from the foot of the bed,” Kattan says. “It’s one of the very few photos I took in Gaza. But I was so surprised. I thought: no one is going to believe me otherwise.”

The longer the doctors stay in Gaza, the more they realise: these are not isolated incidents — this is systemic. These bullets were fired deliberately.

Research by the New York Times

Feroze Sidhwa reached the same conclusion in the fall of 2024. After attending a conference in the U.S., where he learned that another doctor had observed the same things he had, he began an investigation in collaboration with The New York Times. They asked 64 American healthcare workers who had worked in Gaza to complete a questionnaire.

The findings, published on October 9, 2024, are deeply concerning. In the article titled “65 Doctors, Nurses, and Paramedics: What We Saw in Gaza”, 44 respondents reported having seen multiple children aged 12 or younger who had been shot in the head or chest. 25 said they had seen healthy newborns return to the hospital—only to die from dehydration, starvation, or infection. 52 reported seeing young children who were suicidal, or who said they wished they had died.

At the time, Joe Biden was still President of the United States. Doctors had already expressed their concerns in an open letter to him, alarmed by the high number of young children dying. But Biden—caught between opposing views within his own Democratic Party—did not respond.

Sidhwa expected the New York Times article to change that. “It’s extremely rare for 65 American healthcare professionals to speak out so publicly,” he said. “Their job is to focus on saving lives.” The article was read millions of times, he says.

But the publication did not trigger the storm of outrage Sidhwa had anticipated. Nor did it lead to a shift in political direction. “It was, in effect, simply ignored by the Biden administration.”

Gamification of warfare

For a brief moment, there is a flicker of hope in Gaza, when a ceasefire takes hold for two months at the start of 2025. But in the early hours of March 18, around 2:30 a.m., that hope is shattered. With large-scale airstrikes, Israel launches an intensified phase of its campaign of destruction — a phase that continues to this day, marked most notably by the full-scale assault on Gaza City.

Doctors watch the situation in the hospitals deteriorate by the day. Mass casualty events are becoming increasingly frequent — sometimes several in a single day. Many of the patients arriving already bear scars from previous bombings. Starvation is leaving both patients and medical staff severely weakened.

Wounded children who no longer have a single surviving family member become an official medical classification: WCNSF — Wounded Child, No Surviving Family.

Feroze Sidhwa, in the middle of his second mission, wakes up that night as the door to the sleeping quarters is blown open. Israel has broken the ceasefire with a wave of large-scale airstrikes. In the dark, the doctors sit groggy and silent, staring into nothing for nearly a minute. They listen to the bombs falling.

“We need to go downstairs,” one of them says.

Within hours, hundreds of patients arrive. Sidhwa begins his shift that night in the emergency department.

“We were just pronouncing small kids dead for the first ten minutes,” he says.

“And the worst thing about this is: they weren’t. Most of them weren’t actually dead yet. Their hearts were still beating. But we picked them up and handed them to a family member. I don’t speak Arabic, but there was one word I came to know: khalas—it means ‘enough’. We had to make choices, so we could treat others. It meant they had to be taken to another part of the hospital—to die there.”

Mark Perlmutter is at Al-Aqsa Hospital that same night and he sees a young boy, lying on the ground. Covered head to toe in grey dust.

‘He was lying in a pool of his blood. He didn’t have a leg. I tried to walk past him. Suddenly he reached up and grabbed my leg pant. He couldn’t talk, but he looked right at me. I watched the pool around him getting bigger and bigger. I had to pull my leg away from him — so I could help another child.”

On the phone, he begins to cry. “I had to step over him,” he says. He hasn’t been able to get the boy out of his mind.

During mass casualty events, doctors are overwhelmed by severely injured patients, making it difficult to maintain an overview. Yet amid the chaos, two patterns continue to stand out to the doctors—patterns that potentially point to war crimes committed by Israel. They find evidence suggesting the use of highly controversial weapons and signs of the gamification of warfare.

Among the many people with mutilations and burns, doctors notice patients arriving with small wounds who are nevertheless in very poor condition.

It turns out they’ve been struck by tiny fragments of metal, shaped like cubes or cylinders. These pieces are so small — just a few millimetres — that doctors sometimes can’t even find an entry or exit wound. But inside the body, they cause what doctors describe as “horrific damage”: organs are pierced, nerves and blood vessels are hit. As a result: patients suffer fatal internal bleeding or are forced to undergo major amputations.

According to Thaer Ahmad, an emergency physician from Chicago, the entry wounds are so subtle that some patients were initially sent home. “Some came back with abdomens full of blood. One of them died while waiting for surgery.”

Nine doctors told de Volkskrant they had encountered these cube- or cylinder-shaped fragments in patients. Some shared photos and videos of these patients hit by fragments with the newspaper.

Earlier, weapons experts cited in the British newspaper The Guardian stated that the injuries are consistent with Israeli-made fragmentation weapons — explosives packed with large quantities of small, cube-like metal particles.

Mark Perlmutter, vice president of the International College of Surgeons, says he regularly found these fragments. “I operated on at least ten people who had them.” He states that he smuggled two metal fragments out of Gaza in his luggage. “I handed them over to the International Criminal Court.”

According to Perlmutter, the fragments are made of tungsten.

Tungsten is an extremely hard metal, nearly twice as heavy as steel. Because of this, it can cause significant damage when scattered after an explosion. Its use in densely populated areas like Gaza is highly controversial, as it is designed to inflict maximum casualties and does not distinguish between civilians and combatants. Amnesty International has long accused Israel of using such weapons in Gaza.

According to the IDF, the claim that Israel uses weapons causing fragmentation injuries is “a blatant falsehood.” “The IDF does not possess or deploy any such weapons. This claim has no basis in fact and represents a deliberate distortion of reality.”

Since early March, Israel has completely blocked aid to Gaza. Two months later, nearly all supplies in the area have been exhausted, and more and more people are dying from systematic starvation. International criticism of Israel is mounting.

In response, starting at the end of May, Israel opened four controversial food distribution points in Gaza, where Palestinians must travel to receive aid. From the very beginning, these proved to be deadly locations. Civilians waiting in line were randomly shot.

Soldiers even admitted this in the Israeli newspaper Haaretz: under orders from their commanders, they fired on groups of civilians who posed no threat. “It’s a killing field,” one soldier said. “Our form of communication is gunfire”. According to him, civilians “know” they can approach the food distribution point once the shooting stops. Another soldier said that among themselves, they refer to this as a well-known children’s game called Salted Fish [Red Light, Green Light, ed.], where children try to approach the “it” player without being caught moving.

Each time a food distribution point opens, doctors in the hospitals see dozens of civilians arriving with gunshot wounds. Most are boys—teenagers and young adults. They are brought in large groups at once on donkey carts. Some still carry empty food bags.

Several doctors notice a pattern in the injuries. The targeted body part differs each day, as if it’s coordinated work, they suggest.

British surgeon Goher Rahbour says he saw five or six patients in one day who had been shot in both arms and both legs, reportedly by the IDF according to eyewitnesses. “Was this for fun?” Rahbour wonders. “Are the soldiers playing a game?”

Renowned British oesophageal and stomach surgeon Nick Maynard from the University of Oxford experienced this as well, when he had to operate on four people in quick succession who had been shot in the abdomen.

Maynard began asking other doctors if they had seen the same. “Every doctor I discussed this with at Nasser Hospital recognised this,” he says. “One day, they saw mostly gunshot wounds to the head and neck. The next day, it was the chest. The other day it was the limbs. Then the abdomen. Or even the testicles. A urology resident told me he had four boys in a single day who had been shot in the groin.” Due to the chaotic conditions in Gaza, Maynard says it was impossible to keep a daily record of which body parts were hit—and how often.

In the past, there have been indications that Israeli snipers experienced game-like elements when shooting at certain body parts. In 2020, Israeli snipers anonymously told the newspaper Haaretz how they tried to break ‘records’ by hitting as many knees as possible in a single day. One of them scored 42.

The IDF does not respond substantively to questions about the pattern observed by doctors. According to the military, it is Hamas that is ‘creating dangerous conditions for civilians’.

Yet doctors keep coming forward with different accounts.

Early-August, American emergency physician Adil Husain has just returned from Nasser Hospital, when he speaks to a crowd in Texas. He points to the absence of foreign journalists in Gaza. “So it falls on us, the health care workers who have been there” he says, “to bear witness.” He says that he feels as his “our duty to speak” for the people in Gaza. In two weeks, he says, he witnessed hundreds of deaths in his ER.

He tells about Ahmed, a 10-year-old boy who returned from a food distribution point with empty bags. “He was brought to my ER, with gunshot wounds to the head, the neck and his abdomen,” Husain says. He tells de Volkskrant that he gave the boy ketamine in his final moments to ease his passing. “I held him closely. And I whispered in his ear: I’m sorry.”

Doctors leaving the region are almost universally consumed by guilt — because they get to leave, while everyone else is left behind.

“After my first mission, I kept in touch with my Gazan colleagues and asked how they were doing,” says Sarmad Tamimi, who returned at the end of July from his second deployment. “But I can’t do that anymore. Because I’m afraid of what they’ll say.”

Their moral duty

It is May 28, 2025, and at the United Nations headquarters in New York, Sidhwa addresses the Security Council. The invitation came at the last minute, forcing him to cancel all his patients at the hospital in Stockton.

“I’m not here as a policymaker or a politician,” says Feroze Sidhwa, tracing the text on the paper before him with his index finger. “I am a physician bearing witness to the deliberate destruction of a healthcare system, the targeting of my own colleagues, and the erasure of a people.”

A month and a half earlier, Sidhwa had returned from his second mission to Gaza. Now, dressed in a gray suit with a green tie, he sits here, giving voice to things that defy description. He looks composed, focused.

‘My patients were 6 year-olds with shrapnels in their heart and bullets in their brains. And pregnant women whose pelvises had been obliterated and their foetuses cut in two, while still in the womb.’

In fact, he would later tell de Volkskrant, his original speech had been “much harsher.” But on the advice of a trusted confidant, he had toned down his words — not to stray too far from diplomatic convention.

Nearly all of the doctors who spoke to de Volkskrant described feeling the same pull as Sidhwa. They go to Gaza to help — to treat the wounded, to save lives. But when they witness the scale of devastation, the number of innocent civilians killed, and how few lives they are truly able to save, they come to realise their task does not end when they return home.

From neutral caregivers, they have become — sometimes reluctantly — public witnesses. So they can tell as many people as possible what their eyes have seen.

It happens to Nizam Mamode, when in the autumn of 2024, he testifies before a British parliamentary committee. During the session, which is broadcast live, the 63-year-old surgeon breaks down.

In the middle of recounting how children, after a bombing, were left lying on the ground — only to be shot at by armed drones, “this happened day after day after day” — Mamode falls silent. He closes his eyes. His lip begins to tremble.

His silence is gently filled by the chair of the committee. “I feel…,” she says, “because you cannot unsee what you have seen.”

For nearly thirty years, Mamode was a member of the Labour Party. He even campaigned for them during the last election. “But now I’ve cut up my card and stopped being a member,” he tells de Volkskrant, “because I’m ashamed of our Labour government. I think they have a moral obligation to act—and they show no signs of doing that. I believe that one day, they are going to be judged very harshly on that.”

It’s a burden nearly all the doctors carry: they come from countries that are traditional allies of Israel. Countries that—even after hearing their eyewitness accounts—have failed to act decisively enough to make Israel stop. And, in the case of the United States, continue to supply the very weapons that make the bloodshed possible.

In Gaza’s hospitals, the doctors try not to think about it. But sometimes, they can’t help it.

When Israel broke the ceasefire on March 18 with a wave of bombings, the corridors of Nasser Hospital quickly filled with bodies and the wounded. “I remember a five-year-old girl,” says Feroze Sidhwa. “Her name was Sham. She was the first kid I could actually save that day. I was sitting beside her on the floor, trying to help her breathe. A piece of shrapnel had gone through her brain and I was just looking at this little trickle of blood coming out of it.’

Amid the chaos, with the screams of children echoing around them, Sidhwa could only think of one thing: “Did I pay for that piece of shrapnel? Was it my neighbour? Or his neighbour? Which American can I email to let them know their grenade has been found?”

ABOUT THIS STORY

Over the past months, de Volkskrant spoke extensively with 17 international doctors and a nurse about what they witnessed in Gaza. Where possible, they supported their testimonies with photos, X-rays, medical notes, and excerpts from diaries. The newspaper saw images of dozens of children with gunshot wounds to the head or chest.

De Volkskrant compiled this photo selection after careful consideration, because the images form an essential part of this investigation. They vividly illustrate the doctors’ testimonies about the patterns of injuries they observed. Where possible, the doctors who took the images consulted with relatives. In some cases, this was not possible, but the doctors shared the images anyway, believing the public interest to be significant: they suspect war crimes. de Volkskrant possesses many more images, but most are considered too graphic for publication.

The newspaper approached doctors who had previously worked in international crisis zones, allowing them to compare the situation in Gaza with past experiences. They are also the last international eyewitnesses.

de Volkskrant asked the doctors to count how many children aged 15 and under they saw with a single gunshot wound to the head or chest—an important indication that they were deliberately targeted. Some doctors had notes or photos; others relied on memory. The newspaper used the most conservative count, excluding children about whom the doctors were uncertain. Children who also had gunshot wounds in other body parts were not included, as deliberate targeting is less certain in those cases. This also applies to the two young boys described by orthopaedic surgeon Mark Perlmutter, who were shot in both head and chest.

Some doctors worked at the same hospital simultaneously, so duplicates cannot be entirely ruled out. However, the doctors consider this very unlikely, as they generally did not see the same patients. The number of children with gunshot wounds that a doctor encountered depended heavily on location and timing. For example, American trauma surgeon Feroze Sidhwa saw thirteen children on his first mission, and none on his second, which partly took place during a ceasefire.

de Volkskrant asked the Israeli army (IDF) about the doctors’ findings. The IDF responded, but questions about deliberately shooting at children were not answered.

Willem Feenstra and Maud Effting: text, main authors

Judith Baas and Rowin Ubink: images

Titus Knegtel and Adriaan van der Ploeg: design

Eleanor Mohren: graphics

Erik Verwiel and Laurie Treffers: data

Joyce Brekelmans: final editing

Corto Blommaert, Anne van Driel, Xander van Uffelen and Monique Wijnans: coordination

The Forever Lobbying Project

“Bye, Marco.” The team queuing back onto the bus was not wearing shorts and cleats but well-made suits and ties. A few rare women stood out in bright colours in the line of chemical industry bosses leaving the gigantic BASF plant in the port of Antwerp, Belgium. They are the chemical “lobby.”

On this chilly February 20, 73 chief executive officers (CEOs) from 17 sectors gathered to sign the Antwerp Declaration for a European Industrial Deal, or Industrial Deal. Almost all of them operate in the chemical sector. Europe’s most powerful lobbying organisation, the European Chemical Industry Council (Cefic), chartered a bus to transport two-thirds of its board of directors, whose members represent companies like Bayer, from Germany, and Syensqo (formerly Solvay), from Belgium.

“Marco,” the mastermind behind this smoothly-run operation just a few weeks before the European elections, is Marco Mensink, director general of Cefic, a Dutchman with a reputation as a fine strategist. Officially, the summit was all about the future of industry in Europe, destabilised by rising energy prices. But not chemicals. And certainly not PFAS (per- and polyfluoroalkylated substances). However, the February 2023 publication of a European plan to ban all of these “forever chemicals,” ultra-toxic and indestructible in nature, marked the start of a lobbying and disinformation campaign of rare intensity.

After a year’s investigation coordinated by Le Monde, the 46 journalists of the Forever Lobbying Project reveal the secrets of this offensive orchestrated by Cefic, PFAS manufacturers and the plastics lobby. Fighting to prevent the banning of these substances, an alliance of polluters is working to shift the burden of environmental corruption onto society and threaten the economic balance of European nations. According to our estimates, the cost of cleaning up Europe’s pollution could exceed €2 trillion over 20 years if PFAS are not banned.

Credit: Stéphane Horel

Lobbying public authorities

In collaboration with Corporate Europe Observatory, a Brussels-based lobby watchdog organisation, the Forever Lobbying Project team has compiled thousands of pages from 184 184 freedom of information requests filed in 16 countries and to European institutions. Published by 29 media partners, our investigation sheds light on the harassment of public authorities by an armada of lobbyists to water down, or even kill, the historic draft ban. From France and Germany to Slovenia, no one seems to have escaped the grip of the “forever polluters.” Nobody, right to the top.

“Clarity.” On the sidelines of the Industrial Deal that day, Mensink repeated the word to Le Monde a dozen times in just 10 minutes: “We need clarity” on the PFAS ban proposal. Investors, he said, “need clarity about what’s going to happen on these chemicals” used in myriad applications – from the most mundane, like toilet paper, to the most technical, like gaskets in chemical plants. “I don’t think there will be a battle with industry on any PFAS,” said Mensink, as the industry is looking for “solutions” to make the ban “workable.” In the closing photo of the Antwerp summit, dressed in old pink, a woman smiles in front of a hedge of charcoal gray jackets – Ursula von der Leyen. Five months later, in July 2024, freshly reappointed as president of the European Commission, von der Leyen promised that “clarity” would be provided on PFAS.

The Green Deal, the flagship plan announced at the start of her first term at the end of 2019, seems a long way off. So does the “Chemical Strategy for Sustainability” which promised, a year later, a “toxic-free environment” by 2030. The PFAS ban proposal had built on this momentum. Shortly afterward, Germany, Denmark, Norway, the Netherlands and Sweden set about developing a text that would affect the entire chemical “universe” of PFAS at once – over 10,000 substances. Without this, more than 4.4 million tonnes of PFAS would be emitted into the environment over the next 30 years.

In February 2023, five countries therefore proposed a “universal restriction” (uPFAS) under the European REACH regulation (Registration, Evaluation and Authorisation of Chemicals), based on the common characteristic of PFAS: their persistence in the environment, which has earned them the nickname “forever chemicals.” In parallel with the five-country club, the European Chemicals Agency (ECHA), an independent EU agency, is examining the issue.

14 industry groups in battle order

The restriction proposal would apply to all uses of PFAS, unless no alternative was available. It is accompanied by precise derogations and time-limited transition periods, of up to 12 years for the most problematic applications, such as medical implants. Despite this, the public consultation on the text resulted in a deluge of contributions. A year earlier, ECHA was overwhelmed by the 500 comments submitted during the consultation on microplastics alone. This time, the agency received 5,642. With over 100,000 pages to read for both the agency and the five countries, the process was considerably slowed down right from the start. Planned for 2025, the adoption of uPFAS is now no longer envisaged before 2026, or even 2027.

This tidal wave was no accident. Two-thirds of the contributions came from economic players. They “have swamped officials and slowed the system down,” said Vicky Cann, researcher and campaigner with Corporate Europe Observatory, a lobbying watchdog NGO. “It’s a classic tactic, designed to delay the regulatory process. Because delays multiply opportunities to weaken it and increase the risk of derailing it.”

Cann’s investigation, like that of the Forever Lobbying Project, shows unequivocally that this campaign was carefully coordinated. More than 900 comments, for example, were sent from Japan, most of them copy-pasted. The American group Chemours (formerly known as DuPont) set up a password-protected online “advocacy portal,” which provides videos, tutorials and sales pitches to its customers. The lobbying budget of this hyperactive player against uPFAS rose from €550,000 in 2017 to over €2.25 million in 2023, according to its declarations to the EU transparency register.

Industry federations from 14 sectors, including manufacturers of batteries for electric vehicles, medical devices, textiles and semiconductors, joined the battle to defend their use of PFAS, so practical because of their resistance to water, grease and the worst temperatures and conditions. Tefal (Groupe SEB), the French maker of non-stick frying pans, even recruited a former parachute commando officer to head up its crisis management and take the lead within the Federation of the European Cookware, Cutlery and Houseware Industry (FEC).

The most seasoned are the plastics and chemicals sectors. They’re the most influential, too. Operating with a dedicated unit, Plastics Europe highlights the “unique combination of properties” that PFASs provide “in demanding applications where safety and performance are a priority.” All high-performance plastics containing PFAS, fluoropolymers, should be spared the restriction and granted an exemption, the umbrella group argues. The best-known of these is Teflon (polytetrafluoroethylene or PTFE).

Apocalyptic blackmail

But the most powerful force in the field is undoubtedly Cefic, which spends over €10 million on lobbying every year and employs nearly a hundred lobbyists. Its “special uPFAS” internal organisation, which Le Monde obtained via a document access request to the French Economy Ministry, details the involvement of some 15 departments within Cefic, under the supervision of Mensink, responsible for the “strategic overview.”

Two units work for Cefic. One is dedicated to the defense of fluorinated gases, many of them PFAS used in air-conditioning systems. The other, called “FFP4EU” (FluoroProducts & PFAS for Europe), is dedicated to coordination with PFAS manufacturers and users. Spearheaded by firms such as the American companies 3M and Chemours, Japan’s Daikin and France’s Arkema, it brings together around a hundred companies and trade associations. In its internal “tips and tricks” document for contributing effectively to the public consultation, FFP4EU explains to its members how and what to respond to each question. Also listed are “DOs and DON’Ts,” such as “avoid emotions” and “avoid submitting position papers that do not contain objective data.”

This instruction is followed to varying degrees. The words “catastrophic” or “catastrophe” are used in nearly 200 lobbying documents we’ve collected. According to this selected apocalyptic blackmail, the restriction alone could “the end of the rail sector” all European rail traffic (according to the rail sector), bring “to a standstill” aviation, the space industry, security and defence (Aerospace and Defense Industries Association of Europe), or “threatens to wipe out the entire EU automotive sector” (Northvolt, Swedish lithium-ion battery manufacturer, now bankrupt). In September 2023, the president of the European Federation of Pharmaceutical Industries and Associations even went so far as to express his “grave concern” to von der Leyen: “As things stand,” he wrote in an email, “we will be forced to cease pharmaceutical production operations in Europe.”

There are no alternatives to PFAS in most applications, the chorus of economic players repeats. That’s why banning them will have devastating consequences for the economy and our societies. When they aren’t demanding a complete withdrawal of the restriction, industrial actors are calling for more waivers, longer transition periods – up to 40 years for semiconductors – and simple adjustments to current regulations, coupled with self-regulation to control emissions into the environment.

Credit: Stéphane Horel

Germany’s about-face

Europe has seen many a lobbying campaign. But this one stands out from the usual routine of Brussels influence by its scale and coordination and above all because the political players were targeted at a very early stage in the process. First and foremost, the EU’s executive arm. With a preference for Thierry Breton, then the internal market commissioner in charge of industry. A few days after the Industrial Deal, in February 2024, the French politician sent a positive signal to the chemical sector before the plenary of the European Parliament. Then there were the members of the European Parliament, used as relays to disseminate lobbying arguments. The NGO Corporate Europe Observatory noted no fewer than 37 meetings on the subject of PFAS since 2023, two-thirds of them with representatives of economic interests.

But the political betrayal of uPFAS came from Germany. Rather accustomed to being cajoled, its powerful chemical industry got in on the act early, while federal agencies had been hard at work on the restriction from the outset. It’s hard to say exactly how and when the about-face occurred at the highest levels of government. However, at the end of September 2023, at an interministerial PFAS coordination meeting, French officials expressed surprise: “The German government made it known that a restriction embracing all PFAS would not be conceivable, which is rather paradoxical insofar as Germany had carried the project.”

A previously unpublished document, obtained by our German partners, shows that lobbying efforts convinced Robert Habeck, the economy minister and vice chancellor, as early as January 2024, even though he is the leader of the Greens. The memo refers to longer transition periods, an exemption for fluoropolymers and the possibility of continuing to produce PFAS on condition that emissions into the environment are limited.

In May, the signal came from the very top, at the French-German political meeting in Meseberg. In a joint statement, President Emmanuel Macron and Chancellor Olaf Scholz torpedoed uPFAS with barely concealed words, condemning the use of “broad product bans.” So when more than 500 industrialists wrote to Scholz in July 2024 to request the “temporary withdrawal, revision and resubmission of the dossier” of restrictions, they knew they could count on a sympathetic ear.

Dramatic turn of events

Several documents reveal that some of the German states home to chemical parks also exerted pressure on the federal government, Breton and the Commission president. “We urge you to abandon the current approach of banning all PFAS, including the harmless fluoropolymers, and then allowing the most important applications via many derogations,” wrote the governments of Bavaria and Baden-Württemberg to decision-makers in July, repeating the industry’s argument word for word. Neither von der Leyen nor Breton responded to our requests for comment.

The slowness they themselves created by saturating communication channels is worrying manufacturers. They couldn’t wait for ECHA’s conclusions. “It keeps me awake at night,” lamented Cefic director Mensink at a conference on alternatives to PFAS in early November in Copenhagen, Denmark. But, he predicted, “you will probably see the new von der Leyen commission come with alternative proposals already now, which is what we’re working on with the Commission.”

The thousands of documents obtained by Forever Lobbying Project journalists bear witness to this: All this time, and despite incessant requests from lobbyists, the agencies of the five-country club and ECHA remained steadfast, set on their mission of adapting the draft restriction to the contributions received. Until November 20.

That day, ECHA published an “update” with the effect of a bombshell. Highlighting the case of fluoropolymers, the agency mentions “alternative restriction options” and for the first time outlines the possibility of maintaining PFAS production if the objective is “ensuring that emissions into the environment are minimised” is respected. This would concern uses “where evidence suggests that a ban could lead to disproportionate socio-economic impacts.” The wording, which is as ambiguous as can be, left everyone perplexed. Tatiana Santos, of the NGO European Environmental Bureau, said: “But what it shows above all is that the industrial lobbies have dodged accountability, turning the biggest pollution crisis in history into a narrow and short-term economic debate, leaving citizens to bear the staggering cost of inaction -costs that would bankrupt polluters if they were held accountable.”

Will “clarity” come from the person who promised it? In the Clean Industrial Deal that Ursula von der Leyen’s new commission is due to present in mid-February 2025, Mensink confidently states that all will be made clear.

The project received financial support from the Pulitzer Center, the Broad Reach Foundation, Journalismfund Europe, and IJ4EU.

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