“Living in Gaza is like living a perpetual trauma”

Tending to wounds and providing psychological support in the Palestinian Territories

Salwa is prepped for surgery to clean and dress her wound.

Palestinian Territories 2019 © Candida Lobes/MSF

Israeli airstrikes on Gaza in the Palestinian Territories killed 11 civilians in November 2019. Doctors Without Borders/Médecins Sans Frontières (MSF) teams working in Dar al Salam hospital treated an 11-year-old girl who lost her entire family and was badly injured during the raids. Her story highlights the harrowing consequences of these attacks for people living on the blockaded strip.

Salwa is slowly waking up from sedation. She feels groggy but she’s already familiar with this sensation. She has undergone several surgical procedures since she arrived at the MSF-supported Dar Al Salam Hospital in southern Gaza. She was brave this time and didn’t cry when she entered the operating theater.  

From her room in the hospital, Salwa can see the Mediterranean in the distance and hear the voices of pupils coming from the school close by. But her brown eyes always look elsewhere. She stares at objects and people in the room, as if there’s something outside she wants to avoid.

“Some days are better than others for her,” explains Rania Samour, an MSF counselor providing psychosocial support in the hospital. “Some days Salwa just bursts into tears and keeps asking to see her family. Other days, she’s more responsive; she smiles and chats with me.” 

Salwa survived an Israeli airstrike that killed her family during the military escalation between the Israeli army and the Islamic Jihad group in the Gaza strip in November 2019. In three days, Israeli airstrikes killed 11 civilians in Gaza, eight of them children. Israeli authorities admitted that a faulty assessment led to the attack that killed nine members of Salwa’s family: Her parents, her brothers, her aunt, her uncle, and her cousins.

Painful memories

Salwa’s family and relatives used to live in shacks built with corrugated metal sheets, some 15 kilometers [about nine miles] south of Gaza City, where they raised livestock. Nothing remains of their homes.

“My mom is a teacher of English,” Salwa explains with the few words of English she knows. “When I’m older, I want to be a teacher like her, but I want to teach Arabic.”

Her grandmother will be responsible for her education now. She and her six grandsons miraculously survived the airstrike. But she has very few means to sustain them.

When Salwa was admitted to the hospital four weeks ago, Samour was there. She hasn’t left her side since.

“She’s just a child and she has to accept that her home was destroyed and her parents are dead,” Samour says. “She has flashbacks of the night when her family was killed and her life was wrecked. She remembers her older sister dragging her out of the debris in thick smoke. She couldn’t walk because of a wound in her foot; she was in pain. Her father was alive, next to the dead body of her mother. She remembers that he was injured, imploring rescuers to take care of his children.”

This is Salwa’s last memory of her father. That night, he was transferred to the intensive care unit of Al Shifa hospital in Gaza. A few days later, he died from the injuries he suffered in the airstrike.

“I had to tell her the truth; I had to protect her from another trauma,” Samour explains. “When I told Salwa that her father was dead, I was hugging her. I could feel her heartbeat. I wish I could bring her family back; it’s the only thing she wants.”

A complicated recovery

Salwa was referred to MSF’s hospital in southern Gaza with open fractures of the right foot and soft tissue injuries.

“Due to the severity of her wound, we needed aggressive debridement to treat Salwa, flap coverage of the bone, and subsequent skin grafting to restore the soft tissues of her foot,” explains Helene Andersson-Molina, an MSF surgeon in Gaza. “The fractures are still healing and are being treated conservatively.”

But bone and tissue sampling showed that Salwa is also suffering from another affliction that is a growing problem for war-wounded people in Gaza: A multi-drug resistant bacterial infection. Wounds like Salwa’s, caused by violent trauma, are very prone to infections, as the skin is ripped apart and the flesh is open, allowing bacteria to enter. The presence of drug-resistant bacteria means Salwa will need to be treated in isolation with a very specific regimen of antibiotics. It also means her road to recovery will be very long.

Dr. Andersson-Molina believes Salwa will eventually regain the use of her foot. But Samour is worried about the girl’s future.

“She might walk again, but the scar will follow her for the rest of her life, just like the psychological trauma of this tremendous loss. Who’s going to take care of her health, of her education?” she wonders. “I see Salwa in her bed and I can’t stop imagining myself as a child, or my own children in this situation. Living in Gaza is like living a perpetual trauma. Our lives are continuously at stake and we have to get used to it.”

Almost 2,000 civilians have died in the last ten years during the Israeli army military operations in Gaza, according to the United Nations Office for Coordination of the Humanitarian Affairs. In the same period, 18 Israeli civilians were killed by rockets or mortar fire from Gaza, according to the organization B'Tselem.

After every military escalation, when a truce is reached and the bombs stop falling, the effects of the violence linger—among houses and lives and ruin and families mourning their dead.