February 06, 2009

Patients who received surgery during the fighting need follow-up care

More than two weeks after the ceasefires, MSF medical teams in the Gaza Strip have expanded surgical, post-operative, and psychological care, particularly for people wounded during the three-week Israeli military operation last month.

More than two weeks after the ceasefires, Doctors without Borders/Médecins Sans Frontières (MSF) medical teams in the Gaza Strip have expanded surgical, post-operative, and psychological care, particularly for people wounded during the three-week Israeli military operation last month.

Identifying wounded people who have not yet received necessary medical follow-up and treating them as soon as possible remains a priority. Two MSF teams criss-crossing the most heavily destroyed areas have discovered that among the severely wounded people they have seen, 20 percent have infected wounds. Five to eight surgical procedures are carried out per day in a temporary MSF hospital in Gaza City.

Risk of infection in wounds that have not been sufficiently cleaned

Time is a concern as risks of infection remain high. “One of our main activities consists of cleaning wounds. This surgical procedure, called ‘wound debridement,’ is an essential one in war surgery,” explains Jean Rijs, an MSF surgeon.

“The first task is to remove the sources of infection: external bodies localized in the wound—be it a bullet, shell fragment, soil—anything that can be reached without risks; bone fragments that are totally separated from the bone and dispersed in the wound and muscles; and dead and infected tissues. In cases where the first surgical intervention was not complete, a second, or even several additional interventions are necessary in order to avoid infection. The later the intervention, the higher the risk of bone or tissue infection. Tetanus and gangrene represent two potentially mortal infections.”

The surgical team also carries out skin grafts or dressing changes while patients are under general anesthesia. The criteria for surgical admissions have been set up to respond to the needs linked to the very high number of wounded people who underwent emergency surgery during the Israeli military operation and require further surgical procedures. The MSF surgical activities are lightening the workload for Palestinian hospitals, which are resuming their usual activities: emergencies and selective surgery.

New patients in need of post-operative care

One hundred and fifty three patients have been included in the MSF post-operative care program in the Gaza Strip since the ceasefires. Activity has risen 40 percent compared to last December in the MSF clinics in Gaza City and Khan Younis. Mobile teams provide post-operative care to patients who can access the MSF clinics. Each day, more than 100 patients come to the clinic in Gaza City. Roughly one-third are new patients, who are consulted by a doctor and a physiotherapist. Approximately half of the new patients are admitted to the MSF post-operative program.

“After every shelling period we have the same type of wounds,” says Michèle Beck, MSF post-operative clinic supervisor. “Most of the time it is wounds with multiple fragments due to shrapnel blast, including open skull injuries.”

Each MSF nurse is performing roughly one dozen dressing changes per day, a time-consuming medical procedure for people with severe wounds or burns who required prior operations. Some of the patients receive physiotherapy sessions. A third MSF post-operative clinic, in the north of the Gaza Strip, will open on Sunday, February 8.

Spontaneous requests for psychological care

Initial group therapy sessions for Palestinian emergency aid workers began this week to help medical workers who were exposed to the fighting and its consequences. Many of them witnessed the violence endured by the population, were faced with the impossibility of accessing wounded people, and were themselves fearing for their own safety. Civil defense workers, including rescue and medical workers and fire fighters, performed nearly 1,300 interventions during the three weeks of fighting—the equivalent of three years’ worth of activity in normal times. Psychological support is also being offered to the families of those who died while providing emergency aid.

Several individuals are approaching MSF directly for psychological assistance, a rare occurance. There are currently two MSF psychologists in the Gaza Strip.

Contact has been re-established with most of the patients who were already enrolled in the MSF mental health program before the end of December. Many of them coped relatively well during the recent violence, even those whose relatives were killed or wounded.

Humanitarian aid rising, but needs not fully covered

Gaza’s population was already dependant on international aid but the needs have risen dramatically.

Almost two-thirds of the population depends on food assistance. Tens of thousands of people are being temporary hosted by other families after more than 5,000 houses were destroyed and tens of thousands of others were partially damaged, according to Gaza’s Ministry of Public Works.

Distributions of mattress, blankets, and hygiene kits are being organized by several aid organizations. The difficulties many other humanitarian providers face in bringing necessary materials and staff into Gaza and the impossibility of importing materials for reconstruction restrict the ability to provide an adequate aid response to Gaza’s population.

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