Treating gunshot injuries in Gaza amid the pandemic

A Report from Mohammed Aghaalkurdi, MAP’s Limb Reconstruction Project Assistant in Gaza: 

In 2012, the UN predicted that by 2020, Gaza would be unliveable. While we are still alive, we are barely living.

In Gaza some 96% of water is undrinkable. We have one of the highest unemployment rates in the world, reaching 64% amongst youth. Children and young people don’t know what it means to travel. After 13 years of unlawful closure and blockade, poverty is soaring and food insecurity is rife.

Two years ago, on Friday, 30 March 2018, thousands gathered in Gaza to demand an end to the illegal closure and the fulfilment of Palestinian refugees’ right of return at the first “Great March of Return” demonstrations.

Ahead of the first protest, Israeli forces positioned more than 100 snipers at the perimeter fence with Gaza. That day alone, they killed 15 Palestinians and injured 1,416.

Since then, more than 210 Palestinians have been killed, including 46 children. More than 8,000 people have been shot with live ammunition, predominantly to their limbs, including 1,200 with particularly severe limb gunshot wounds.

MAP, in partnership with IDEALS, has been working to support the development of local services to treat complex limb injuries in Gaza since 2014.

When the protests began, we were one of the first organisations to respond, and have provided essential medical supplies including out-of-stock medicines, disposables and over £1 million of equipment for orthopaedic surgery. OCHA has recognised MAP as “the only organization dealing with late and complex limb reconstruction injuries in Gaza.”

I have been working with patients injured with gunshot wounds and their families for the past two years now. It is not easy seeing a patient’s eyes turn red with pain and despair because of these devastating wounds. But nothing compares to seeing them burst with joy when they are reassured about their injury and treatment plan.

Most limb injuries we see have extensive damage to the bones and the surrounding soft tissue and neurovascular bundles (a structure combining nerves and veins). This makes it much more susceptible to a wound’s worst enemy: infection. Between 25% and 40% of patients with gunshot wounds develop some degree of bone infection over a 12-month period following their injury.

Gunshot wounds also cause huge bone gaps and non-unions (when a broken bone fails to heal) which sometimes directs the medical decision towards shortening the limb for a period of time. This can make a patient’s road to recovery even longer.

Occasionally, when the injury is bad enough and expected to expose a patient’s life to danger, the decision to amputate is made. Over 150 limb injuries have resulted in amputation, and, if you think that cutting the limb off represents the end of the suffering, then you have not heard about patients who have to endure more surgeries or sometimes further amputations. At least 94 patients needed secondary amputations due to subsequent bone infections.

The work I support at MAP, limb reconstruction treatment, is unique. It requires a multidisciplinary team made up of orthopaedic and plastic surgeons, nurses, physiotherapists along with psychosocial support professionals. It also involves countless check-ups, complicated surgeries, heavy metal frames, frequent dressings and bloods, strong medicines, pain, insomnia, a sense of helplessness and disability… and much more besides.

Lucky patients have a swift recovery, but others, many others, have a very long, hard and expensive recovery sometimes lasting for years. Recently, the limb reconstruction clinic, where I am often based, recorded a patient whose date of injury goes back to the military offensive on Gaza in 2008. It has been 12 years and he has undergone 25 minor and major surgeries and is about to have more.

Most patients I meet have lost their jobs due to their disabling injury, which hugely impacts their already vulnerable lives and households. One patient told me, “I was very active. I used to run an educational business. I was also a gardener. But a bullet broke it all, I’m frozen still, unable to move even one centimetre from my bed, waiting for some donation to meet my family’s needs.”

Thankfully, there are many success stories too. I will never forget a man who completed his Master’s degree and became a father while receiving treatment.

This year marks the seventh phase of the project. It has been described by the Ministry of Health as one of the best projects ever supported by a charity in Gaza because of its focus on developing local skills and capacity.

With freedom of movement so severely restricted for people in Gaza it is very difficult for health professionals to access the training and professional development they desperately need outside. Alone we would not have been able to treat the high number of patients with complex gunshot wounds.

An important part of the project is the missions of expert surgeons and rehabilitation specialists that travel from the UK to Gaza. During missions, the visiting surgeons work with local medics to evaluate and operate on patients with complex injuries. The missions cater to the needs of the local clinical team, providing hands-on training, symposiums and workshops.

Sadly, since the outbreak of COVID-19, planned medical missions have had to be postponed. To maintain the relationship with the specialists in the UK, virtual meetings via video calls are now conducted weekly with the local team, where they discuss clinical cases and decide on treatment plans for patients.

Back in March, when a state of emergency was announced, we also had to suspend other activities. Local outpatient clinics were closed, and elective surgeries were postponed, leaving dozens of patients waiting in line for medical care.

The local outpatient clinics and surgeries have now resumed, but we are minimising the number of patients there and taking important precautionary measures.

Everyone involved in the project is working hard to overcome the disruption caused by the outbreak of COVID-19, to make sure it has the minimum impact on patients’ treatments.  I’m really proud of all we’ve achieved these past two years and look forward to helping more patients take their first steps towards recovery.

This article originally appeared in the Autumn 2020 edition of our supporter magazine, Witness.

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