First steps towards recovery: How MAP is helping Hosam walk again after he was shot

"It was a Friday. I woke up early as usual, did my morning routine, and when it was afternoon I went to the mosque and prayed. I had lunch at home with my family before my cousin came to our house. He asked me to go with him to land that we own to tend to the potato crop, just 400m away from the [perimeter] fence.

“On that Friday a lot of people were protesting at the fence, we saw them but never approached. The Israeli soldiers were throwing [tear] gas canisters at the protesters, and these reached us. All of a sudden, a bullet hit my legs, going through my left leg and lodging in the right leg.”

20-year-old Hosam* is a keen footballer from Jabalia Refugee Camp. He is one of 8,000 people who have been shot with live ammunition, predominantly to their limbs, since the “Great March of Return” protests began in Gaza on 30 March 2018. More than 210 Palestinians have been killed, including 46 children. Though Hosam was not at the protests, his experience is typical of the approximately 1,200-1,700 people who have received particularly severe limb gunshot wounds over the last two years.

Medical Aid for Palestinians (MAP), in partnership with IDEALS, is supporting Gaza’s health sector to treat complex and horrific limb injuries. Our work there includes regular surgical missions, on-the-job training for local teams, and providing costly limb reconstruction equipment to local hospitals. OCHA has recognised MAP as “the only organization dealing with late and complex limb reconstruction injuries in Gaza.”

Below Hosam describes what happened from the moment he was shot, and through the long and complicated recovery he is making with MAP’s help:

“My 17-year-old cousin was in a shock, he couldn’t do anything. A group of guys saw and rushed over to help me. They provided first aid after calling an ambulance. It took an hour for the ambulance to arrive. I was on the ground, started to faint, couldn’t see anything; I could only hear what was going on around me. The ambulance arrived and drove me to Beit Hanoun hospital in the north of Gaza. My cousin called my family telling them what happened. When my family arrived the situation was so bad and the damage was so severe that they asked my father to sign a consent form to allow them to amputate my leg, but my father refused and I was moved to another hospital".

When Hosam reached the hospital (Indonesian Hospital, in northern Gaza), he was immediately operated on again and fitted with an ‘external fixator’, a frame to support his damaged limb, vital given that he had lost a section of bone to the gunshot wound. He also underwent vascular repair surgery for the damaged blood vessels.

"When I woke up, I was surrounded by my father, mother, brothers and a nurse. I looked immediately at my leg, and thanked God they didn’t amputate it.  My mum was crying next to me so I wiped her tears away and told her don’t be sad, I will be fine.”

The doctor told Hosam the time after his operation was critical, explaining: “If the blood pumps again through the vessel we repaired then you have to thank God, if not we will have to amputate your leg.” Thankfully, a pulse was found and his leg was saved from amputation.

Hosam spent three days in the intensive care unit and another month in the hospital ward, surrounded by his family, encouraging him through his journey to recovery.

Despite follow up at the Indonesian Hopsital and an MSF clinic,  Hosam’s leg wasn’t responding well, so he was referred for medical care in Egypt. At the border crossing he was examined by a doctor. While he was waiting to pass to the other side, they told him that his access had been denied, denying him from entering Egypt. After another referral, he was refused entry again, without being given a reason for the denial. A third referral was written to Al Makassed hospital in East Jerusalem, but again he was unable to exit, this time via the Israeli-controlled Erez crossing.

Hosam was referred to the MAP-supported Orthopaedic Department at Gaza’s largest hospital, Al Shifa, run by Dr. Mahmoud Mattar. There he met MAP’s Limb Reconstruction Project Assistant, who collected information about his injury and put his name forward to be seen by the orthopaedic specialists visiting Gaza from the UK on one of the regular medical delegations run by MAP and our partners IDEALS.

The MAP/IDEALS mission team arrived and examined Hosam. They explained his injury and the treatment he needed. Hosam described the way they communicated as “extraordinary,” with the team carefully asking him about his concerns and answering his questions.

On the next limb reconstruction mission to Gaza, Hosam was operated on by the visiting medics. He was fitted with a second external frame used in specialised recovery. Screws were inserted into his leg to allow the bone to be remodelled and straightened. Stimulan, a calcium sulfate paste provided to hospitals in Gaza by MAP, was also applied to treat bone infection.

After the operation, Hosam received follow-up care from the the local limb reconstruction clinic. During the next limb reconstruction mission, he was operated on again and a treatment plan was developed for lengthening the bones in his leg to fill the gap left by his injury. With continued support from the local limb reconstruction team in Gaza, Hosam’s leg began to heal.

"Each time the MAP/IDEALS mission team proposed a treatment plan, I followed it happily because I saw how much my leg improved".

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When the mission was in Gaza in August last year, the team worked toward helping Hosam to bear weight on his leg. Within a month, Hosam was able to stand, and by October he started to walk, fully weight-bearing without crutches, and his frame was removed by the visiting medics.  The team applied a cast for three weeks, and Hosam continued to receive follow-up care locally.

On his last visit to Al Shifa’s Orthopaedic Department, Hosam was told that the gap in his bone had repaired.

"Despite my bone fully healing, I'm not enjoying perfect physical ability yet. I'm still limping, can't play football like before. When I see my friends playing, I feel  inferior.

“ I hate to visit the place where I was shot, till now I still have flashbacks of the day of the injury and it's like I'm living what happened over and over. I always have nightmares about that day.

"I have a strong determination; I will not surrender easily. I will swim again, I will play football again and I will continue studying to be a psychologist. I will never give up."

Thanks to our supporters, MAP has been able to help Hosam take his literal first steps toward recovery. Please donate today to help us continue saving limbs in Gaza.

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*Name changed to protect identity

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