Not just a painful memory: Continuing to treat the Great March of Return’s gunshot wounds

Three years ago, on 30 March 2018, a series of widespread civil society-initiated protests began in Gaza. Dubbed the “Great March of Return”, these weekly demonstrations demanded the lifting of the illegal 13-year closure of Gaza and right of Palestinian refugees to return to the homes they fled or were expelled from in 1947/8.

Protest camps were set up at five locations along the Gaza perimeter fence, hosting Palestinian music and dance performances, food sellers, and talks where older members of the community could share their memories of their homeland with younger generations. On recurrent Fridays until the end of 2019, thousands of Palestinians marched from these camps towards the perimeter fence, where Israel had deployed more than 100 snipers.

A woman paints a Palestinian flag on a boy's face

The protests, which an independent UN Commission of Inquiry determined were “civilian in nature”, were met with the widespread and systematic use excessive force by Israeli forces, including live ammunition, rubber-coated steel bullets and tear gas. As a result, 214 Palestinians were killed, including 46 children. A further 36,100 people were, including 8,800 children, were injured. By the end of 2019, 156 limb amputations were performed, and around twenty-seven people were paralysed as a result of spinal injuries. At least three health workers were killed and 845 injured.

According to the World Health Organization (WHO), more than 7,000 people were shot with live ammunition, predominantly to the lower limbs. Of these, approximately 1,200 suffered particularly devastating injuries involving significant bone loss, requiring expensive and painful long-term reconstruction treatment to repair their damaged limbs.

A painful legacy, three years on

Almost everyone in Gaza knows someone who was wounded or killed at the “Great March of Return”. Many have suffered not only the pain of their injuries, but also loss of income, education, and opportunity. Instead of greater rights and freedoms, the legacy of the protests has been further agony and despair for Gaza’s two million inhabitants.

Gaza’s beleaguered and aid-dependent health system was teetering on the brink of collapse even before the influx of new injuries, as a result of chronic shortages of essential medicines, equipment, medical specialists, and fuel needed to keep hospital generators running through daily electricity outages. Since 2020, Gaza’s meagre healthcare resources have been further stretched by the arrival of COVID-19. The need to focus on pandemic emergency response has had severe knock-on impacts for other services. Around 3,500 elective surgeries are being postponed each month, with the waiting list having reached 11,400, including hundreds still needing treatment for injuries incurred at the Great March of Return.  

An injured man is carried by medics on a stretcher

Meanwhile, justice and accountability remain elusive for the victims of the “Great March of Return”. Meaningful investigations have not been carried out into potentially serious violations of international law during the protests, including the killing and injuring of health workers.

MAP’s continuing response: Fixing limbs, restoring dignity

Since 2014, MAP and our partner IDEALS have facilitated regular medical delegations of surgeons, radiographers, physiotherapists and nurses from the UK to Gaza as part of our limb reconstruction programme. These multidisciplinary teams have provided surgeries for patients and on-the-job training for local teams in the latest skills and techniques in treating the most complex limb injuries. MAP has also provided more than £1 million of equipment for limb reconstruction, including essential medicines, disposables, and costly frames needed to stabilise wounds.

This work resulted in the establishment of Gaza’s first dedicated Limb Reconstruction Unit staffed and run by a team of skilled Palestinian surgeons, nurses and technicians. When the “Great March of Return” began, the preponderance of devastating gunshot wounds caused by Israel’s use of live ammunition against protesters put these services in high demand.

Over three years, this programme has been helping patients overcome their agonising injuries. Since March 2018 MAP has facilitated 12 surgical missions to Gaza, and a total of 675 limb reconstruction surgeries have been performed by the Unit. Not only have patients been able to recover functioning in their damaged limbs, they have reported increased mobility, lower pain and less anxiety following their treatment.

But many are still undergoing treatment, with many of those wounded at the protests still requiring surgeries, in addition to those newly injured through industrial and road accidents and other incidents. Dr Mahmoud Matar, senior orthopaedic surgeon at Nasser hospital, recently explained to MAP the continued importance of this project:

“Firstly, Gaza is continuously a hot zone for conflicts. In 2019, when Gaza was still healing from previous wars and escalations, the “Great March of Return” started and caused a huge influx of patients and complex injuries that the health system was not ready to address. Secondly, we continue to lack necessary resources and equipment. Without those items, we cannot help our patients heal and thus cannot prevent subsequent disabilities.”

Despite temporary suspensions in outpatient clinics and surgeries due to the diversion of healthcare resources during the pandemic, this project is continuing to serve injured Palestinians. While MAP and IDEALS had to postpone in-person medical missions to Gaza since March 2020, volunteer clinicians from the UK have maintained their relationships with local specialists through weekly video calls where they discuss clinical cases and decide on treatment plans for patients.


Ahmad’s two-year journey to recovery

Ahmad standing, on his way to work

Ahmad*, a young man in his early 20s, was shot in the right leg while attending the protests in March 2019. Before he was shot, Ahmad was studying for a diploma in architecture and had an active social life with family and friends, all of which were restricted by the pain of his injury, frequent medical treatment, and reliance on walking aids. Ahmad also had to stop his work helping his father working in construction, placing additional financial burdens on his family.

As well as the direct injury, Ahmad was one of the 25 – 40% of gunshot victims to develop a bone infection, which left him with a significant bone gap requiring additional surgery and medication. Through the MAP and IDEALS project, he had already undergone five surgeries. He was fitted with a frame to stabilise the wound that was removed more than a year after his injury, in July 2020. Ahmad described to us the confidence he felt in the local team providing his care throughout:

“They heard me very well and always gave me the reassurance I looked for. Therefore, I was not one of those who requested referral abroad. Also, in between check-ups, whenever I had any question about my condition, I would just call doctors on the phone anytime, and they responded promptly.”

He also explained how comfortable he was in the hands of the visiting MAP-IDEALS teams from the UK:

“I had the chance of meeting them twice, and they also operated on me when I was struck severely by an infection. Their medical advice was invaluable, and quickly after their intervention I heard the good news that the frame would be removed from my leg.”

Despite the intensive treatment he has so far received, this is not the end of Ahmad’s recovery journey. His injured leg healed several centimetres short and slightly misaligned, meaning that he may require further surgery in future. Ahmad nevertheless remains optimistic. He recently found a desk job as an accountant in a grocery store (see picture above right, showing Ahmad on his way to work with his frame removed), and intents to register soon to continue his diploma:

“I have worried many times because of my physical impairment and its consequences. But I accepted what happened to me as part of my destiny, and I trust that I will resume my studies and work someday soon.”

*Name changed to protect identity


Thanks to the generosity of our supporters, MAP is able to provide long-term recovery for patients like Ahmad even as we respond to the needs emerging from COVID-19 pandemic. We are also ensuring that Gaza’s hospitals are equipped with the skills and services they need to respond to future emergencies. Please consider making a donation to our work today:

Donate

Keep up to date

Sign up for our newsletter to receive all the latest updates from our programmes, campaigns and fundraising appeals.