Supporting the development of Gaza’s physios through training in the UK

Israel’s 2014 military offensive on Gaza killed 2,217 Palestinians and left approximately 11,000 injured. Many limb injuries required complicated surgical intervention. To support these patients, IDEALS and Medical Aid for Palestinians (MAP) began training a permanent team of surgeons, nurses and physiotherapists at Gaza’s Al-Shifa Hospital, establishing Gaza’s first Limb Reconstruction Unit. For some staff, this training included study in the UK.

Nour*, a physiotherapist at the Limb Reconstruction Unit, was recently in the UK for two months training at King’s College Hospital. MAP caught up with her in London to find out more about her work and how her time in the UK helped her to develop professionally so she can best support her patients in Gaza:

Tell us about your work at the Limb Reconstruction Unit at Al-Shifa Hospital  

“I joined the limb reconstruction team in 2015. My experience before the project was in orthopaedics.

“Our team in Gaza team were visited by a physiotherapist from King’s College Hospital.  We discussed [with them] patients’ cases and how best to treat them. This gave me new experiences and I became better able to support limb reconstruction patients who need qualified physiotherapists with specialist skills, as limb reconstruction is a long and complex process with many stages.”

What motivates you to work in limb reconstruction?

“In Gaza, after every Israeli offensive, we receive a lot of cases of injured people with serious complications. Patients tried before to exit Gaza for treatment, but this is very difficult because our borders are closed completely and have been for a long time.

“When you can do your best for a patient it is a very rewarding job. I met a lot of patients in the outpatient clinic at Gaza who had suffered for a long time with very complicated injuries. Our team do wonderful work and now many patients are back to their normal lives. This is the most important thing, when you feel that there are many successful stories, this makes me proud and happy.”

Is there a patient who left a particular impression on you?

“A lady, she was injured in the last Israeli offensive on Gaza and lost her husband, two brothers and all of her children. She had a very complicated injury and when she got to Israel [for treatment] they said they wanted to amputate her leg. My colleagues worked with her and now she can walk.

“The first time I saw her she was in a wheelchair and looked very frustrated and depressed. When I met her it was very sad to hear her story.

“Before I came to the UK she was able to walk again. I saw her walking, it was amazing and she was smiling.

“I remember a man who lost everything, his house and his money, to pay for treatment until he found our team. Our team worked with him and now he can walk and has returned to work and can support his family again.

“People in Gaza are suffering a lot, so when you can do something for these patients you must be proud and happy.”

Tell us about physiotherapy in Gaza

“In Gaza we work as general physiotherapists, there are no specialised physios. Maybe, with my colleague, I am the first physio to begin to specialise in limb reconstruction.

“There are courses for physiotherapy training in Gaza, but the main problem is that most of the courses are short. We must be more specialised. This is the main problem for us. I want to work on this point when I go back to Gaza.”

Tell us about your journey to the UK for training at King’s College Hospital?

“We [Nour and her colleague] had been waiting since 2015 to come here [to the UK] to study. We applied many times for a visa and worked very hard for this opportunity. After two years we were given permission to exit through the Egyptian crossing, Rafah.

“But when we were at the Rafah border the Egyptian authorities said “go back” to my colleague. This was shocking and made me very unhappy.

“I kept crying, I said “no, no I can’t go alone”. I talked to my colleague and told him I wanted to go back to Gaza with him, but he said to me, “no, go!”

What have you learnt from your training at King’s College Hospital?

“I have gained a lot of new skills. Before coming to the UK, I knew very little about nursing and the removal of frames [correction devices used to reconstruct limbs].

“I have observed patients before their operations and in the outpatient clinic, when doctors make a clinical assessment to determine if the patient requires a frame or not. I have also observed patients after their operation in a ward and in the outpatient clinics.

“I have gained a lot of skills in outpatient care and learned about adjusting and removing frames. I have also observed the physiotherapists from Kings College in the gym and learned more about how to choose exercises that are suitable at each stage of a patient’s treatment.” 

Will you be staying in contact with the physios you have met at King’s College Hospital?

“When I go back to Gaza I can contact the physios from King’s College for advice, this is very helpful.”

What are the differences in physiotherapy practice at King’s College Hospital compared to Al Shifa Hospital in Gaza?

“In Gaza we work in a similar manner to King’s. But there really is a difference, we have a shortage of rooms. As a physiotherapist I need a gym in the inpatient clinic for patient exercises but we don’t have a gym. 

“Also here [in the UK] you can find everything; crutches and all assistive devices are available. But in Gaza sometimes there are shortages in assistive devices, like splints for patients with lower limb injuries, sometimes without these our job is difficult.

“I will try, when I go back, to get another room and redesign it as a gym for inpatients. This would be very helpful for the patient, helping them to build up their muscles, range of movement and get back to their normal life.

“I will try my best to transport my experience from King’s College London to Gaza.”

What contact have you had with your team in Gaza whilst you’ve been in London?

“There is a weekly Skype conference with the limb reconstruction team in Gaza. The team in Gaza tell the surgeons at King’s all information about their patients.

“When I talk to my colleagues in Gaza I feel that they are very frustrated and depressed there. Everything is hard in Gaza, we deal with a very complicated situation. But now I have a lot of hopes and a lot of motivation. I want to give my colleagues a positive push.”

“I will take all the experience I have gained at King’s College Hospital and pass it onto other colleagues in Gaza.”

What are your hopes for the future, for Al-Shifa hospital and the limb reconstruction team?

“I have a lot of hope for the hospital, for the team and for all physiotherapists to have access to training and be more qualified.

“In our hospital the people are very depressed and frustrated. Palestinian people want to work, to create everything but the life is very difficult because we haven’t electricity, we live in the dark, all borders are closed around us.

“It is very difficult for people in Gaza. We can’t tolerate all of these problems in our lives. Our houses have been destroyed many times, our schools and our hospitals too. I pray for freedom for my country and for Palestinian people. We want to live. I want to see my children and all Palestinian children play like here [in the UK].

“I experienced freedom here. I keep thinking, I hope all people in Gaza can know the meaning of freedom.”   

*Name changed to protect identity       

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