24 May 2019
In Gaza the need to develop neurosurgical services is crucial. Israel’s repeated military offensives on the territory and, most recently, violence against Palestinians at the ongoing “Great March of Return” demonstrations have resulted in high numbers of severe head trauma and complex spinal cord injuries. Without appropriate surgical management such trauma cases can result in lifelong disabilities or even death.
Two neurosurgical units can be found in Gaza, at Al Shifa Hospital in Gaza City and European Gaza Hospital in the south. Back in 2015, Medical Aid for Palestinians (MAP) conducted an assessment which identified that neurosurgeons working in the two units lacked the skills to conduct complex neurosurgery, and struggle to access professional development opportunities outside of Gaza. As a result surgeons often refer complex cases to hospitals in the West Bank, including East Jerusalem, or abroad, without guarantee that these patients will be able to exit due to Israel’s restrictions to patients’ permits, and risking their safety during their transfer if they do.
With support from high-profile surgical experts from Birmingham and Cardiff in the UK, MAP is now helping to develop neurosurgery capacity in Gaza. In February 2019, a group of UK neurosurgeons were again in Gaza with MAP, where the team met Ayman.
Ayman is 32 years old. He came to the Emergency Department at the European Gaza Hospital four months prior to the February neurosurgical mission, complaining of severe headaches. He was also suffering from dizziness and blurred vision. In December 2018, an MRI scan revealed a large intraventricular tumor, bleeding into his brain's ventricule. He was referred for urgent surgery outside Gaza but, like many Palestinian patients, his application was rejected by the Israeli authorities.
On the first day of the neurosurgery mission he was seen by visiting Consultant Neurosurgeon, Dr Georgios Tsermoulas, and local surgeons. Together they discussed with Ayman his options of surgery to remove the tumor, including the risks. They explained to him that if he did not undergo the procedure he was in danger of dying.
The next day Ayman underwent a five-hour operation performed by Dr Tsermoulas, alongside local surgeons, Dr Nidal, Head of the Neurosurgery Department at European Gaza Hospital, Dr Ashraf, Dr Anwar, Dr Ahmad and surgical residents, using a technique the local team hadn’t witnessed previously. After surgery Ayman was admitted to the Intensive Care Unit. A brain CT scan showed the success of the operation, with the removal of 80% of the tumor and no bleeding on the residual part.
Two days after the operation, Ayman was moved to a ward. The next day he was semi-conscious, but a little disoriented and irritable. He could move both hands and right leg but had limited movement on his left side. Together with a UK neuro physiotherapist, Ayman was supported to move his left side, to keep both limbs functioning.
Ayman later developed hydrocephalus, a buildup of fluid on his brain. The local team helped him, inserting a shunt to drain the excess fluid. He improved significantly and was discharged from hospital. Without the support from Dr Tsermoulas and his team it is likely Ayman would have died, having been denied access to treatment outside Gaza. Ayman is doing extremely well and can now walk, talk, listen and is back to his every-day life.
Dr Tsermoulas and the rest of the multidisciplinary team will be returning to Gaza later this year, with three more missions planned. With your continued support, MAP is confident that these interventions will lead to long-term improvements in patient care and safety. MAP would like to thank the visiting expert volunteers for their time and energy.
Please donate today to help MAP continue to support training and development for Palestinian medical professionals in Gaza.
Patient’s name changed to protect identity
