While such severe wounds and high rates of infection would usually require the wounded to be hospitalized, the overburdened health system in Gaza cannot accommodate such a high number of patients.
Mohammed Abu Gaza, 25, was shot on April 6 near Rafah. His knee shattered, but he was repeatedly discharged from the hospital.
“Six days after I was shot I was discharged to make space for the wounded,” he said. “I kept going back to the hospital with fever and pain, but they wouldn’t admit me, because they were full.”
After being referred by MSF to a different hospital, he had another operation but eventually, the same thing happened: “I stayed one week there, but then they discharged me again to make way for the next wave of wounded.”
An economic burden
The effects of wounds like these are rippling throughout Gaza, burdening the wider society with the costs and responsibilities of care, in a place where years of occupation, war, internecine conflict and political infighting, and blockade, have brought the economy to the brink of collapse.
Unemployment among the 15-29 age group—which makes up two-thirds of MSF’s patients—has reached 60 percent, according to the World Bank. If patients previously earned wages, in many cases, their families have now lost the support that their income provided and are bearing the extra burden of their care.
“Before I was injured I sometimes sold vegetables from a cart in the market, but it was only enough to bring me money for cigarettes,” said Abu Gaza. “Now I just sit in the house—I can’t do anything by myself, even washing. I have to ask the family for help with everything.” Another patient who was shot on March 30, described how his father, a government employee, had to borrow $1,500 from relatives to pay for the treatment he needed. “Before, sometimes I worked with my friends and relatives on building sites," he said. "I really miss this. I am not able to earn money now. My relatives abroad are sending money for my treatment.”
Mental health consequences
The consequences are not just economic, however. As well as being a hairdresser, Hamidiyyeh was a caregiver for her sick father. “It hurts me that I can’t help my dad,” she said. “Now I need care as well as him.” The accumulation of physical pain, financial stress, and social pressures is causing mental difficulties for many of the patients. “It’s hard—24 hours a day, I’m just sitting in the house. Honestly, it’s destroyed my life, and the life of my family,” Hamidiyyeh said, downcast.
Over two months have passed since the days of the heaviest casualties, a period that would see normal fractures heal. For many of those in Gaza, progress has not nearly been so quick, due to the complexity of their injuries. “They will need five to six months to heal, if they heal at all,” said Dr. Rodaix. “Our patients can be divided into three groups of roughly equal sizes: those who will eventually heal, those who will need extra surgeries to heal, and those who will need specialized reconstructive surgery over the course of years if they are to have any chance of healing.” This type of surgery is unavailable in Gaza, however, leaving many people facing the possibility that they will never regain the function of their limbs.
Back at Friendship Hospital, Drs. Rodaix and Wynands have succeeded in pulling across the section of muscle they needed to fill the wound after some tense moments. A section of the skin from the thigh had been grafted onto the wound to close it, and the team started to relax as the long hours of surgery came to an end. “This operation was representative of the fact that you think, ‘this is not so bad’,” said Dr. Rodaix, “but the wounds are so bad here that you never know what you will find inside.” She was hopeful that the patient would manage to avoid further infection with the wound closed. However, for him and many others, with bones missing and the blockade in place, the long-term future is far from certain.
