26 July 2023
In the summer of 2021, a few months after Israel’s devastating 11-day military offensive on Gaza, 31-year-old Mahmoud from Gaza City was working in his chicken shop at a busy market when an explosion nearby destroyed his shop and caused severe injuries to his leg. He was transferred to Shifa Hospital, in central Gaza, and X-rays revealed 30 fractures in his leg.
Mahmoud’s lower leg was secured in an external fixator to stabilise the broken bones, and an internal plate was placed in his upper leg to avoid complications and the risk of amputation. Mahmoud was also at risk of nerve damage, so doctors operated on the area to protect it.
After a few weeks of treatment, doctors suggested amputating Mahmoud’s leg and he was left with the choice of either amputation or multiple painful, complicated, and expensive surgeries, and the risks that come with limb lengthening such as bone infection or nerve damage. The one-time Mahmoud agreed on amputation, his blood sugar was high and, given that he is diabetic, the anesthesiologist and doctors cancelled the surgery.
“How could I agree to amputation? It is very difficult. I decided to receive treatment at Shifa Hospital for three months and then travelled to Egypt to seek further treatment,” said Mahmoud.
He had six surgeries abroad in seven months before returning to Gaza. These included placing external fixators back on his thigh and leg, skin graft and bone debridement, femur internal fixation and leg lengthening.
Following the surgery, Mahmoud continued to feel pain. The medication he was taking was very expensive and he couldn’t afford it. “Sometimes I just put up with the pain,” he said. His pain increased significantly during the winter, and he remained mostly in his bed. Due to the increased nerve sensitivity resulting from the internal plate, Mahmoud explained: “I felt like I was being electrified. It was so painful, and I slept for only two or three hours a day.”
“This injury has affected me greatly, but my goal has always been to give My Children a decent life.”
Mahmoud was then referred to Nasser Hospital’s limb reconstruction unit, where Medical Aid for Palestinians (MAP) are leading on limb reconstruction services. At the unit, Dr Mahmoud Matar – one of Gaza’s most senior limb reconstruction surgeons – operated on him. After six long hours of surgery, Mahmoud’s condition improved greatly, and he was able to place his leg on the floor and walk.
A new external fixator was placed over Mahmoud’s leg to grow healthy new bone tissue and to allow surgeons to accurately move bones to their correct anatomic alignment.
After having the fixator fitted, Mahmoud was able to go home. But he explains how his life had changed: “With the frame on it is very inconvenient. It is screwed into your leg. I had three pins just below my knee at two-inch intervals and they went through the skin and into my bone. Where the fracture was in my ankle, I had three rings fitted with a horse-shoe shape frame. More than 10 pins went through my leg at this point. This made it uncomfortable trying to sleep at night – I had three kilograms of metal in my leg.”
“I got used to it after a while but because of the open wounds I was not allowed to get it wet, so I had to shower with a black bin bag over my leg for a couple of months. I was on crutches for a long time. Getting dressed was difficult – I had to have trousers altered to make them fit over the frame.”
Mahmoud’s wife got some of his trousers tailored for him. They now have a zip and cover the fixator keeping it, along with his leg, warm and safe from dust and bacteria. She takes good care of him and has been extremely supportive throughout this immensely difficult time in Mahmoud’s life. Mahmoud would wake her up to support him while going to the toilet and lean on her when he couldn’t use his crutches.
Mahmoud also paid tribute to Dr Matar and the team at the limb reconstruction unit: “I was so glad to have been referred to Dr Matar and I’m grateful as I don’t think I would have received this level of care and expertise elsewhere. He never once rushed to make decisions, he always listened, answered my questions, and put my mind at rest. He was very reassuring in everything he did. I am truly grateful to him and his team. They were amazing. Because of him, I am making good progress with my recovery and I am able to resume my life.”
Mahmoud still has a length discrepancy between his legs; one leg is shorter by 12 centimetres. But his condition no longer limits his daily activities, especially going to the bathroom and taking a shower. He has started walking on his leg a little bit, sometimes without his crutches. His life is now stable, and he is independent again. “I live on the third floor, I used to climb the stairs in seconds, climbing two stairs at a time,” said Mahmoud. But he is happy that he can at least climb the stairs by himself now.
During a limb reconstruction mission involving surgeons from MAP in February 2023, Mahmoud was hoping for more surgery. But the number of patients in need of limb reconstruction treatment vastly exceeds the number of surgeons, despite them working 12-hour shifts, day and night. Mahmoud’s surgery was therefore rescheduled until the next mission in May, but then cancelled again due to Israel’s most recent five-day military offensive on Gaza.
Mahmoud’s treatment journey has been long and complex, and it is not over yet. He still needs to undergo bone grafting, where Dr Matar will take bone from his ribs and transplant it in his leg to fill the current hole, and possibly another limb-lengthening procedure.
For now though, Mahmoud is enjoying being able to do the things he loves with less discomfort. “I just want to secure the future of my children. This injury has affected me greatly, but my goal has always been to build them a house and give them a decent life,” he said.
Please donate to MAP’s work supporting limb reconstruction services in Gaza.
MAP has been working for almost 10 years to improve limb reconstruction services in Gaza. We wish to thank the incredible 50 volunteers from around 18 NHS hospitals across the UK who contribute their valuable time and expertise to this vital work. The achievements of the service would not be possible without their commitment.
Photo: Mahmoud at Gaza’s Nasser Hospital. (Credit: Reflection Media / MAP).
