In this assignment, I reflect on six real-life scenarios from the Gaza

Strip and explain how I, as an Advanced Nursing Practitioner (ANP),

apply international human rights frameworks to protect my patients.
Working in Gaza under blockade and war is extremely difficult, but
our ethical duty as nurses becomes even stronger in such crises. My
role is not just to provide bedside care during emergencies, but to
lead, advocate for rights, document violations, and create systems
that ensure continuous and dignified care despite the impossible
circumstances .

‫ لكن ممكن تخليها أكثر تأثيرًا بإضافة جملة مثل‬،‫ المقدمة قوية‬:‫اقتراح لغوي‬:
"These cases are not theoretical exercises, but daily reality for
healthcare workers in Gaza, where international law is often the only
shield protecting patients' dignity."

Case One: Grandma Fatima

Law: Universal Declaration of Human Rights (UDHR, 1948) -
Article 1 (Right to Dignity)

The Situation:
Grandma Fatima is 78 years old. She was displaced from her home
in northern Gaza and now lives in a tent in Deir al-Balah. She has
diabetes and high blood pressure. Before the war, she received
regular care, but now her medications are unavailable. She came to
the hospital very weak, with a blood sugar level of 600. A nurse
commented, "She is old, and we have limited supplies. We should
save them for younger patients who have more life ahead."

The Violation: Age discrimination and denial of dignity.

International humanitarian law prohibits discrimination in
healthcare, and the UDHR guarantees the right to dignity for all
regardless of age .

My Intervention as ANP:

 I perform a full assessment of Grandma Fatima. I check her vital

signs, blood sugar, kidney function, and overall condition. I
document that her deterioration is directly caused by lack of
medication access due to the blockade .
 I go directly to the charge nurse and explain that denying care
based on age violates the UDHR and our ethical duty. Age does not
determine a person's right to life.
 I write in Grandma Fatima's file detailed documentation: her age,
her medical history, the comment made by the nurse, and how
delayed care will worsen her condition. This documentation is
crucial for accountability .
 I talk to the doctor and the pharmacy team. Together we find a way
to provide her essential medications, even if in limited quantities,
because partial treatment is better than none.
 I sit with Grandma Fatima and listen to her story. She tells me about
losing her home, her children, and her dignity. I hold her hand and
tell her she matters. Psychological support is as important as
medical care .
 Continuity of Care: Before she leaves, I coordinate with
community health workers who visit displacement camps. They will
check on her regularly and help her access medications when
available. I also register her for any upcoming medical aid
distributions.
 System Level: I report this incident to the hospital administration
and propose a clear policy: triage and care must be based on
medical need, not age. I cite the UDHR and international
humanitarian law in my report .

Case Two: The Village of Khirbet Ikhza'a

Law: ICESCR (1966) - Article 12 (Right to Health)

The Situation:
Khirbet Ikhza'a is a village east of Khan Younis, near the border.
Most of its residents are farmers who lost their land. The village has
no health clinic since the nearest one was destroyed. Pregnant
women give birth at home without medical support. Children have
not received vaccines for two years. When a child gets sick with
diarrhea, the family cannot get oral rehydration salts. Some children
have died from preventable dehydration.

The Violation: This is a violation of the right to health under

ICESCR. The blockade and destruction of health infrastructure have
made healthcare inaccessible for entire communities .

My Intervention as ANP:

 I visit the village with a mobile health team. We conduct a rapid

needs assessment: number of pregnant women, children under five,
chronic disease patients, and urgent medical needs. We document
everything .
 I see a child with severe dehydration. I administer IV fluids on the
spot and teach the mother how to prepare oral rehydration solution
at home using simple ingredients.
 I talk to the community health workers in the area. Together we
identify the most vulnerable families who cannot reach any health
facility.
 I write a detailed report about the village situation and send it to the
Health Cluster and international NGOs working in Gaza. I request a
regular mobile clinic for this village .
 I coordinate with UNICEF to include this village in the next
vaccination campaign. Children here have missed critical vaccines,
putting them at risk for preventable diseases.
 Continuity of Care: I train two women from the village as
community health volunteers. They learn to recognize danger signs
in pregnancy and childhood illness, and they know how to contact
our team when someone needs help. This creates a sustainable
system .
 Advocacy: I document the names and conditions of patients who
need care outside Gaza, especially cancer patients and children with
congenital conditions. I submit their names to the WHO for medical
evacuation coordination, knowing that more than 20,000 patients
are waiting .

Case Three: Little Youssef

Law: Convention on the Rights of the Child (CRC, 1989) -
Article 24

The Situation:
Youssef is 4 years old. His family's house was bombed in Gaza city.
He survived but lost his left leg below the knee. He was fitted with a
prosthetic leg, but the growth of his bones has made it painful and
unusable. He needs a new prosthesis and rehabilitation, but the only
rehabilitation center was destroyed. His mother carries him
everywhere. She is exhausted and depressed. Youssef has stopped
speaking and playing.

The Violation: This violates the child's right to the highest

attainable standard of health and rehabilitation under the CRC.
Children with disabilities are entitled to special care and support .

My Intervention as ANP:
 I assess Youssef completely: his physical condition, his pain level,
his psychological state, and his developmental milestones. I see he
is regressing because of lack of stimulation and mobility.
 I talk to the physical therapy team. We learn that the Jerusalem
Princess Basma Centre has recently opened a new rehabilitation
department at Al-Ahli Hospital . I refer Youssef immediately and
coordinate his appointment.
 I sit with Youssef's mother. I listen to her exhaustion and validate
her feelings. I connect her with a psychosocial support worker who
can help her process trauma and care for her own mental health.
 I write in Youssef's file all the barriers he faces: destroyed
rehabilitation center, lack of prosthetic services, and his mother's
psychological distress. This documentation supports future
advocacy for rehabilitation services.
 I coordinate with a local NGO that provides mobility aids for
children. They agree to help with Youssef's new prosthetic leg and
follow his progress.
 Continuity of Care: I create a long-term plan for Youssef: regular
physiotherapy sessions, developmental stimulation activities his
mother can do at home, and monthly follow-up to adjust his
prosthesis as he grows. I train his mother on these activities.
 System Level: I document the gap in pediatric rehabilitation
services and submit a report to health partners, advocating for more
child-focused rehabilitation programs in Gaza .

Case Four: Mr. Ibrahim

Law: Convention on the Rights of Persons with Disabilities
(CRPD, 2006) - Article 25

The Situation:
Mr. Ibrahim is 55 years old. He used to be a builder. An airstrike
near his home caused a wall to collapse on him, injuring his spine.
He is now paralyzed from the waist down and uses a wheelchair. He
needs regular follow-up and bladder care to prevent infections. But
the field hospital where he goes has no accessible toilets. The
entrance has a step he cannot cross without help. The bathroom
door is too narrow for his wheelchair. He stopped going for follow-up
because he feels humiliated asking strangers to carry him.

The Violation: This violates the CRPD, which guarantees

accessibility and equal access to healthcare for persons with
disabilities. Lack of accessibility is discrimination .

My Intervention as ANP:
 I go to Mr. Ibrahim in the camp where he lives. I assess his
condition: he has early signs of a urinary tract infection because he
cannot maintain proper hygiene without accessible facilities.
 I apologize for the humiliation he experienced and acknowledge that
the healthcare system failed him. I tell him this is not his fault, but
the system's failure.
 I write a detailed report about the accessibility barriers at the field
hospital: the step at the entrance, the narrow bathroom door, the
lack of accessible toilets. I document how this directly harmed Mr.
Ibrahim's health.
 I take this report to the hospital administration and the NGO running
the field hospital. I demand immediate modifications: a portable
ramp for the entrance and at least one accessible toilet. I cite the
CRPD and explain that this is not a luxury but a legal obligation.
 I coordinate with an occupational therapist to visit Mr. Ibrahim at
home and teach him techniques for bladder management and skin
care to prevent pressure ulcers.
 Continuity of Care: I arrange for community health workers to
visit Mr. Ibrahim weekly to check for early signs of complications. I
ensure his medications for bladder infections are delivered to him
when needed.
 System Level: I advocate for all health facilities in Gaza to conduct
accessibility audits and make necessary modifications. I collect data
on patients with mobility impairments who face barriers, to support
funding proposals for accessibility improvements .

Case Five: Mrs. Amal

Law: Convention on the Elimination of All Forms of
Discrimination Against Women (CEDAW, 1979) - Article 12

The Situation:
Mrs. Amal is 32 years old, pregnant with her fourth child. She lives
in a tent in Rafah. She has severe anemia and malnutrition. When
she went to the maternity clinic, the doctor briefly examined her
and said, "You're fine, this is normal in pregnancy. Go home and
rest." He did not order any blood tests or iron supplements. Another
woman in the clinic, who arrived later, received immediate attention
because her husband was a local official. Amal went home feeling
dismissed. Three days later, she collapsed and was brought to the
emergency with severe anemia requiring blood transfusion.

The Violation: This is gender discrimination and failure to provide

adequate maternal care. CEDAW requires equal access to
 healthcare without discrimination. Maternal mortality in Gaza is
rising due to such neglect and lack of resources .

My Intervention as ANP:

 When Amal arrives in the emergency, I prioritize her stabilization.

She receives two units of blood and close monitoring. I document
her hemoglobin level upon arrival: 5.2, dangerously low.
 I sit with Amal after she stabilizes. I let her tell her story. She cries,
saying she felt invisible at the clinic. I validate her experience and
tell her she deserved better care.
 I review her prenatal record and see that no blood tests were
ordered in her entire pregnancy. I document this gap in her file.
 I go to the maternity clinic supervisor and report what happened. I
explain that dismissing a malnourished pregnant woman without
assessment violates CEDAW and endangers lives. I request an
investigation.
 I coordinate with the nutrition team to provide Amal with high-
protein supplements and iron tablets for the remainder of her
pregnancy.
 I talk to the social worker to assess Amal's living conditions in the
tent. She has no clean water, no proper food, and no way to rest.
We arrange for a hygiene kit and a better tent through a shelter
partner.
 Continuity of Care: I assign a community midwife to visit Amal
weekly until delivery. She will monitor her blood pressure, check for
anemia signs, and ensure she takes her supplements. I coordinate
with the hospital for a planned delivery with blood available.
 System Level: I document this case and propose mandatory
anemia screening for all pregnant women in displacement camps. I
advocate with health partners to increase iron supplementation
distribution in maternal health programs .

Case Six: The ICU at Al-Shifa Hospital

Law: WHO Constitution (1946) - Right to Health

The Situation:
The ICU at Al-Shifa Hospital is partially functioning. The generator
runs only six hours a day due to fuel shortages. Ventilators stop
working when the generator is off. Staff manually bag-ventilate
patients during power cuts, but last week, a patient died when the
ventilator stopped and there were not enough staff to bag everyone.
The hospital director asked staff not to report this, saying it would
"affect morale."
 The Violation: This violates the right to health under the WHO
Constitution. Patients have the right to safe, continuous care. Staff
have the right to a safe workplace. Covering up deaths due to
system failures prevents accountability and improvement .

My Intervention as ANP:

 When I learn about this incident, I first ensure all current ICU
patients are stable. I assess the ventilator situation and confirm that
without 24-hour power, patients are at constant risk.
 I write a detailed incident report: the date, the patient's condition,
the ventilator failure, the manual ventilation efforts, and the
outcome. I document that the fuel shortage caused this death. I
keep a copy for myself.
 I talk to the hospital director privately. I explain that transparency is
essential for patient safety. Covering up this death prevents us from
advocating for fuel and prevents systemic change.
 I contact the Health Cluster and WHO fuel coordination team. I
provide data on ICU fuel needs and request urgent fuel supplies for
Al-Shifa. I emphasize that patients are dying preventable deaths .
 I gather the ICU nursing staff and hold a debriefing session. They are
traumatized by the death. I acknowledge their heroic efforts and
provide psychological first aid. I connect them with mental health
support services.
 Continuity of Care: I work with the biomedical engineering team
to prioritize ICU equipment for any available power. We create a
contingency plan: which patients need manual ventilation first
during outages, and how to rotate staff to prevent exhaustion.
 System Level: I advocate with humanitarian partners for
sustainable fuel solutions for hospitals. I join a working group on
hospital safety during power outages and contribute nursing
perspectives to the advocacy messages .