Every Friday, volunteer medic Asmaa Qudih goes through a tense ritual: She prays, kisses her mother's hand, and packs a bag with medical supplies as she heads off to the weekly mass protests, which have degenerated into ongoing rioting, along the Gaza Strip border fence with Israel.
Treating the wounded has become dangerous for Gaza's emergency workers. In the past five months, three medics have been killed by Israeli army fire, while dozens more, including Qudih, were hurt by live fire or tear gas canisters.
Qudih, 35, says the weekly routine is terrifying, but adds that national pride, religious devotion and professional ambition drive her and other medics to risk their lives.
"As long as you go to work in the field, you expect at any time to get injured or killed," she said on a recent Friday as she prepared to head to the area.
Before leaving home, she inspected her red backpack, filled with bandages, tape and saline spray, which soothes the effects of tear gas on eyes and skin. She hugged her young nieces and nephews, and then solemnly kissed her mother farewell.
In the latest violence, witnesses said volunteer paramedic Shorouq Msameh was shot in the back Friday while standing about 300 meters from a fence during a protest east of Rafah as demonstrators tried to launch a burning tire toward Israel. Msameh, who was wearing a white coat marking her as a medic, is now in critical condition at a hospital in nearby Khan Younis.
The plight of Gaza's medics lies at the heart of a debate over Israel's use of force in the protests. European and U.N. officials, along with international rights groups, accuse Israel of using excessive force, citing the large numbers of civilian casualties, including medical workers. The U.N. and World Health Organization have both said Israel is obligated to allow medics to work safely.
Israel accuses Hamas of using the protests as a cover to carry out attacks and says it is defending its border from infiltration attempts. One IDF soldier has been killed by a Gaza sniper.
Israel denies targeting medics and even tries to protect them but accuses terrorists of mixing in with the crowds. Last month, Israel said a Palestinian nurse from the group Doctors Without Borders tried to carry out a late-night cross-border shooting attack on IDF troops. Israel apparently killed the man, but has not revealed details.
In a statement, the IDF said that the medical workers operate very close to the fence "and are often mixed in between those carrying out attacks and those acting violently."
The military stresses that commanders "repeatedly and emphatically" order their troops to avoid harming medical workers.
The soldiers generally hold fire when medical personnel are near the border, "even though this can heighten risks to soldiers by allowing Hamas terrorists to approach," the IDF said in a statement.
"Nevertheless, despite these efforts, unintended harm to medical personnel may have been unavoidable in such volatile, challenging and chaotic situations."
The statement said the deaths of medical personnel are being investigated.
Qudih never planned to work at the protests, which are aimed in part at trying to end the blockade of Gaza imposed by Israel and Egypt to weaken Hamas. The weekly protests include remote arson, in which protesters launch burning kites and balloons over the border fence into Israeli territory, where they land and spark wildfires. Tens of thousands of acres of Israeli farmland, forests and national parks have been lost to Hamas arson attacks.
In addition to the fires, a spike in the more conventional terrorist attacks from Gaza in the form of rockets and mortars was recorded last month.
On March 30, the day of the first march, Qudih walked about 30 minutes from her home in the southern town of Abassan to the nearest protest site to watch.
She saw thousands of Palestinians marching close to the border, burning tires and hurling rocks and firebombs in the direction of IDF soldiers, who responded with live fire and tear gas.
Fifteen people, mostly young men, were killed that day, and hundreds more were badly wounded. Protesters and medics struggled to evacuate the wounded, in many cases carrying them "improperly and hastily" to ambulances or private cars, she recalled.
Noticing the shortage of paramedics, Qudih volunteered as an emergency responder.
"Seeing the injured in front of me gave me the courage to provide them the needed service," she said.
The job has proved to be dangerous. In five months of violent clashes, 125 Palestinians have been killed and about 4,500 others have been wounded by gunfire, according to Gaza health officials and rights groups. Palestinian officials say the vast majority were unarmed civilians, but Hamas itself has also confirmed that dozens were Hamas operatives.
Among the dead have been three paramedics, including Razan Najjar, a 21-year-old woman who also worked as a volunteer with Qudih in the Khuzaa protest camp. All wore white or fluorescent uniforms identifying themselves as medics. Rescuers typically walk slowly, their hands raised, when approaching the border to treat the wounded.
Witnesses said Najjar had just helped treat a protester when she was shot in the chest. Qudih, who did not see the incident, said word spread quickly among her colleagues.
"We collected ourselves and hurried to the hospital, all the medics," she said. "There was big pain and shock."
At least 100 medical workers have been injured by gunshots, shrapnel and direct hits from tear gas canisters, according to al-Mezan, a leading Gaza-based rights group.
Qudih herself was hit with a tear gas canister dropped from a drone on May 14, the most violent day of the marches, in which about 60 Palestinians were killed. The canister knocked her unconscious and she was briefly hospitalized and required stitches.
Being unemployed, Qudih said she hopes health officials will offer her a job. But she said her main motivation is her "national and religious duty" – and to remember her friend, Razan Najjar.
"We continue our volunteer work here in great part as an honor to Razan," she said.
