A group of 45 American physicians and nurses who volunteered in hospitals across Gaza have sent an open letter to US President Joe Biden and Vice President Kamala Harris sharing their experiences and demanding an immediate ceasefire and arms embargo.

The signatories unanimously described treating children who had suffered injuries they believed must have been deliberately inflicted. “Specifically, every one of us on a daily basis treated pre-teen children who were shot in the head and chest,” they wrote.

“We wish you could see the nightmares that plague so many of us since we have returned: dreams of children maimed and mutilated by our weapons, and their inconsolable mothers begging us to save them. We wish you could hear the cries and screams our consciences will not let us forget.”

Many in the group have public health backgrounds and experiences volunteering in other conflict zones such as Ukraine and Iraq, according to the letter. “We believe we are well positioned to comment on the massive human toll from Israel’s attack on Gaza, especially the toll it has taken on women and children,” reads the letter posted to X on Thursday by Dr. Feroze Sidwa, who spearheaded the writing of the letter with the other physicians.

“We believe our government is obligated to do this, both under American law and International Humanitarian Law, and that it is the right thing to do,” the letter said.

The ‘only independent monitors’ in Gaza

“In Gaza, there’s no independent monitor,” he said. “If you’re not going to believe the Palestinians, then you should believe 50 doctors who’ve gone there at different times and places.”

Apart from Palestinian journalists living in Gaza, there has been no media access to the enclave since October 7, with a few exceptions of entry under official escort.

Hamawy signed the letter to recount what he saw with his own eyes. “We all saw a complete devastation of a society, of people’s lives, of health care structure,” he said.

Hamawy has worked as a surgeon in Sarajevo, in New York City on 9/11, and in Iraq, where he performed life-saving surgery on US Senator Tammy Duckworth in 2004 after her helicopter was hit by an RPG. But he said those experiences in other conflict zones were not comparable to what he had witnessed in Gaza, adding that 90% of those he had seen killed there were women and children.

Hamawy worked at the European Gaza hospital in the southern city of Khan Younis in May of this year where he performed about 115 reconstructive surgeries and treated mostly children under 14 years old. He worked on amputations, burns, and gunshot wounds to the face, he said.

Another patient was a little boy who picked up what he thought was a can of tuna to bring back to his family in Rafah, Hamawy recalled. But the metal object was in fact an unexploded cluster bomb, according to Hamawy, who said that after opening it in front of his family, the child lost his left arm, both his legs, and three fingers on his right arm.

‘No kid gets shot twice by a sniper by mistake’

The photos were sent to him by a first-year medical resident who had been forced to perform the surgery and requested Perlmutter’s expertise. When Perlmutter asked why senior surgeons hadn’t done the operation, the resident explained that they had been killed in a bombing.

Describing a hospital overrun, Perlmutter said after every bombing, he would find injured children laid across the floor, their loved ones panicking and crying.

“Some are dead, some will die in front of you, and some you can save. You try to save the ones you can save,” Perlmutter said.

He recalled two patients aged around six years old, who had suffered gunshots to their heads and chests – wounds which suggested they had been deliberately targeted, he said.

“No kid gets shot twice by a sniper by mistake,” Perlmutter said, adding that the shots were “dead center” to their chests.

As Perlmutter tried to treat the children with head injuries, he said, their “brains poured out” in his hands, in what he described as a personally traumatic moment.

‘Everyone in Gaza is sick, injured, or both’

Launched in response to Hamas-led terror attacks in Israel on October 7 which killed at least 1,200 people, Israel’s monthlong military offensive in Gaza has left more than 39,000 Palestinians dead, according to the Gazan Health Ministry. The letter’s signatories estimate that the true toll of the war could be in excess of 92,000, if it included deaths from starvation or disease and bodies still buried under the rubble.

Last week the World Health Organization said the polio virus had been found in sewage samples, putting thousands of Palestinians at risk of contracting a disease that can cause paralysis.

Under such conditions, the American medical workers warned that epidemics could lead to the deaths of tens of thousands more children. The displacement of people to areas with no running water or toilets “is virtually guaranteed to result in widespread death from viral and bacterial diarrheal diseases and pneumonias, particularly in children under the age of five,” the letter said.

“Everyone in Gaza is sick, injured, or both,” with few exceptions, their letter said. “We are not politicians. We do not claim to have all the answers. We are simply physicians and nurses who cannot remain silent about what we saw in Gaza.” the letter said.

Reporting contributed by Tala Alrajjal, Sam Fossum and Eugenia Ugrinovich.