22 August 2023
Six-year-old Mariam from Khan Yunis, in the south of Gaza, was involved in a serious accident when a teenager collided with her, while he was trying out his new roller skates, and then accidentally stood on her upper leg. After suffering from pain in her leg for some time, Mariam was referred to the limb reconstruction unit at the European Gaza Hospital, in the southern city of Khan Yunis, in August 2022.
“The moment Mariam fell, I knew something was horribly wrong. She started screaming and crying uncontrollably and we rushed her to the hospital,” said Mariam’s mother, Sanaa, recalling the accident.
Following a series of tests, it was found that part of Mariam’s femur – the large bone in the thigh – was infected. Soon after, a biopsy confirmed that she had osteomyelitis. Osteomyelitis is a painful bone infection and, as in Mariam’s case, it usually occurs in the leg. If it is detected early, osteomyelitis can be treated solely with antibiotics. But if not, it can require surgery.
Osteomyelitis is usually detected via an MRI scan, but this type of medical imaging is not available in Khan Yunis, so Mariam was only able to have a CT scan. Her infection was picked up late, after having an MRI scan at Shifa Hospital in Gaza City. Mariam’s family was told that she did not need surgery – however, they should bring her back if she later developed a fever. Seven days later, Mariam had a fever and was taken back to the hospital. Doctors performed a surgery where they removed pus from her leg, cleaned it and applied a cast. She had to stay in the hospital for several days.
Mariam’s condition improved a little after removing the cast, but Sanaa was worried about her health and used to carry her everywhere they went. Mariam was also feeling generally unwell and had low energy levels and little appetite.
When she returned home, Mariam was walking down the stairs at her home one day and she fell again. She suffered another fracture, just two weeks after her first injury, and had to have surgery. She underwent four hours of surgery where doctors at the hospital placed a stabilising frame called an ‘external fixator’ to her leg, to hold the broken bones in their proper position. This external fixator uses metal pins or screws that are placed into the bone through small incisions into the skin and muscle, which are attached to a bar outside the skin.
Mariam’s grandfather, Zaki, who is a retired nurse, took care of her throughout her diagnosis and surgery. “I used to work in hospitals, and I know all the technicalities. I know how hard this is on Mariam, as well as my daughter and my son in law. I want them to feel reassured,” he said.
Mariam and her grandfather in the European Gaza Hospital. (Credit: Reflection Media / MAP).
For 100 days, Mariam had to move with an external fixator and missed out on many of the sports and activities she loved doing. “Mariam is a very energetic child; she enjoyed swimming, trampolining, and dancing. She hasn’t done any of these activities for a couple of months due to the pain she suffered in her leg,” said Sanaa.
“I’d like to thank MAP from the bottom of my heart. We wouldn’t be where we are today without you all.” – Mariam’s grandfather.
Mariam and Sanaa spent most of their summer in 2022 doing indoor activities like colouring, reading and household tasks. Mariam’s family had to adapt the clothes she wears to fit over the rings of the frame in her leg. Her grandfather Zaki bought her tracksuit trousers that have zips or buttons, to help them fit over the frame. But Mariam preferred to wear dresses and skirts.
Showering was also a challenge. The frame cannot be submerged in water, and perfumed soaps or shower gels should be avoided, as none of the wounds should get infected. Sanaa had to thoroughly dry Mariam’s frame with a fresh towel and clean all her pins every time she had a shower.
The fixator was finally removed after 100 days and the wounds in Mariam’s leg were left to heal. But her leg remained loose and soon broke again. By this time, in February 2023, Medical Aid for Palestinians (MAP) volunteers were in Gaza for a limb reconstruction medical mission and examined Mariam at the European Gaza Hospital’s limb reconstruction unit. The team decided to place another external fixator on Mariam’s leg to maintain its length, alignment, and the rotation of the bones.
“This will be Mariam’s third surgery. The first was to remove pus from her leg, after which she suffered from acute osteomyelitis, the second and third were placing external fixators. She will continue to be on medication, and I hope the surgery will now help. Mariam was fully healthy before her injury. She used to go to nursery and play. It has now been almost a year since she was injured,” said Zaki.
Since February, MAP has been following up with Mariam’s treatment journey. She has been feeling better and moving slowly. “The last operation she had by the UK volunteers gave her a pain-free life. She can sleep, which improved her mood overall, and she is able to dance slowly without the fear of being in pain. Maybe because this is her second time wearing a fixator, she has got used to it,” explained Sanaa. Mariam now places a pillow under or around her leg while she sleeps to keep it still and to form a barrier, so the rest of her body doesn’t rub against it.
In June 2023, MAP’s volunteer surgeons were back in Gaza and followed up with Mariam. The plan was to remove her external fixator but after imaging and scanning, the surgeons decided to adjust the alignments of the external fixator until the bone is fully healed and to prevent any fracture. Mariam’s family are now planning some outdoor activities this summer including a picnic at the beach.
“I’d like to thank MAP from the bottom of my heart. We wouldn’t be where we are today without you all, from the limb reconstruction unit who found the infection on Mariam’s first X-ray, to the orthopaedic doctors who looked after Mariam when she had her surgery. Then the nurses and staff who took care of Mariam during our follow ups,” said Zaki.
Please consider donating to MAP to support limb reconstructions services and other emergency and complex hospital care work 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 wouldn’t be possible without their commitment.
Photo: Mariam in the European Gaza Hospital. (Credit: Reflection Media / MAP).
