Children mutilated in Gaza face further risks without special care

Eleven-year-old Noor’s left leg was almost completely amputated when her home in Jabalia, Gaza, was hit by an explosion in October. Now her right leg, fitted with a heavy metal rod and four screws drilled into the bone, may have to be amputated.

“It hurts a lot… I’m afraid they’re going to have to amputate my other leg,” she said from her hospital bed, looking down at her clumsy brace.

“I used to run and play, I was so happy with my life, but now when I lost my leg, my life became bad and I became sad. I hope to get an artificial limb.”

In bombarded Gaza, a generation of maimed children is emerging as Israel’s retaliation after deadly Hamas attacks on October 7 led to blast and crash injuries as explosive weapons tore through densely packed high-rise apartment blocks.

Israeli authorities have previously said they are working to minimize harm to civilians. Israel’s military spokesman’s unit pointed to Hamas’ strategy of “exploiting political structures for terrorist purposes,” but did not provide a specific comment on the mutilated children.

Also read: Israel continues to attack Gaza hospitals, targets displaced Palestinians

Doctors and aid workers say Gaza’s damaged medical system is unable to provide the children with the sophisticated aftercare they need to save their severed, still-growing bones. Only 30% of pre-conflict doctors are working because of killings, detentions and displacement, according to the World Health Organization.

More than 1,000 children had undergone leg amputations, sometimes more than once or on both legs, by the end of November, according to the UN children’s agency UNICEF, in a conflict where Gaza health authorities say almost a quarter of injuries are among children.

Poor sanitation and drug shortages are leading to more complications and mutilation of existing injuries, some of which may not survive, doctors say.

“Many limbs that were apparently saved will need amputation. And many (people with) amputations and limbs that we think have been saved may go on to die from the long-term effects,” said Dr. Chris Hook. British emergency doctor with medical charity MSF who returned from Gaza at the end of December.

Flies and rot

Staff at the European Hospital in Gaza where Noor is being treated, which is operating at triple capacity, cannot provide the new member she dreams of.

Even painkillers to help amputees with chronic pain are running out, staff say. Flies buzzed around the chamber when a Reuters journalist visited.

“I try as much as I can to make things easier for them as a nurse, but no matter what you do, they have serious psychological problems, they feel incomplete with a lot of pain,” said nurse Wafa Hamdan.

The enclave’s main prosthetic limb center, the Qatari-funded Hamad Hospital in Gaza City, was closed weeks ago after the Israeli strike, Gaza health authorities say.

Palestinian teenager Ramadan Basal, whose limb was amputated after being injured in an Israeli strike, sits in a wheelchair as he receives treatment at the European Hospital, in Rafah in the southern Gaza Strip, December 28, 2023. PHOTO: REUTERS

Israel’s military spokesman’s unit did not immediately respond to a request for comment about Hamad Hospital.

Children with war-related amputations will need up to a dozen surgeries on the limb by the time they reach adulthood because the bone continues to grow, experts say.

But even before the conflict there was a shortage of vascular and plastic surgeons, doctors say, and Palestinian health authorities say more than 300 health workers have been killed since then.

However, Noor, whose right leg can survive intact, is luckier than some children whose limbs are quickly amputated due to lack of time or medical expertise, sometimes without anaesthetics.

Palestinian Noor Marouf, whose limb was amputated after being injured in an Israeli strike, sits in a wheelchair as her aunt helps her at the European Hospital, in Rafah in the southern Gaza Strip, December 28, 2023. PHOTO: REUTERS

“Unfortunately a lot of it is really unnecessary,” said Sean Casey, coordinator of the WHO’s emergency medical teams.

Other times, amputation is the only option because injured children arrive at the hospital days after the injury.

UNICEF spokesman James Elder said he saw a child whose injured left leg had begun to decompose because he had been stuck on a bus for more than three days due to delays at a military checkpoint.

Israel’s military spokesman’s unit said an operational briefing was held to draw immediate lessons from the incident and that it would be looked into further.

“No one comes to see them”

While Gaza’s health authorities have no official tally, doctors and aid workers say UNICEF’s figure of 1,000 is accurate for the first two months of the conflict, but has likely been inflated since then, making mutilation rates in Gaza unusually high compared to other conflicts and disasters.

In Ukraine, where rockets also hit residential towers during the Russian invasion, there are 30 known cases of children being mutilated, according to the Ombudsman’s office.

The British-Palestinian surgeon Dr. Ghassan Abu-Shitah said he performed six amputations in Gaza overnight. Once, he had to reopen a child’s thigh stump after amputation to clear pus.

MSF’s Hook also reported that many people were returning to the wound care clinic in Rafah with infected stumps.

Palestinian girl Eman Al-Kholi, whose limb was amputated after being injured in an Israeli strike that killed her parents, lies on a bed as she receives treatment at the European Hospital, in Rafah in the southern Gaza Strip, December 28, 2023. PHOTO: REUTERS

International Committee of the Red Cross president Mirjana Spoljaric said she could not forget the images of children, often orphans, with multiple amputations lying in hospital wards after visiting Gaza in December. “On top of the wounds you see and the lack of painkillers, they’re lying there and no one comes to see them.”

In some cases, as with 10-year-old orphan Ritash from Gaza, her right leg had to be amputated again higher and just below the knee after it became infected, according to Gemma Connell, an official with the UN humanitarian aid office (OCHA). met her.

One photo showed her scowling from a wheelchair on a grimy hospital floor, her trunk jutting into the air. “I think what I’ve seen would break anybody’s heart,” Connell said.