Mohamed’s story

Twenty-eight year-old Mohammed was shot during the ‘Great March of Return’ demonstrations in Gaza. He currently waits to find out whether he will be able to travel to Jordan to receive further treatment for the gunshot wound on his right leg.

The surgery he needs is not currently available in Gaza. Without it, he may not regain the full function of his leg and could face a lifetime of disability.

“I was injured during the ‘Great March of Return’ protest on Friday 6 April.

I knew it was dangerous to go, but I went to the protest anyway — everybody did. I was on my way to work and then at the last moment, I changed my mind and decided to go to the demonstration. I was with friends and one of them also got injured. But not as badly as me.

I was just standing there when I got shot. It felt like the bullet shattering my bone. My friend tried to find the missing bits of bone, but he couldn’t.

I was shot in the right lower leg. Now I have nerve damage and bone missing in my leg.

I’ve had six operations so far, including debridement operations and an operation to close the wound. Then I was told I might need to undergo an amputation after closing the wound. At the start, I was coming to the MSF clinic daily to receive treatment. Now I go three times a week for physiotherapy and to have the dressings changed on my leg. After receiving physiotherapy, I feel better. The spasms decrease and moving my muscles is easier.

At first, when I got shot at the protest, I didn’t let anyone come near me because it was too dangerous. Then the ambulance arrived and they took me to hospital.

I live with my parents. It was different when I was working, I had some money and could contribute. But now they care for me as best they can. It’s tough.

I haven’t been back to the demonstrations: I don’t move, I can’t move. I stay at home.

It has been four months since I have been shot, and I hope to get a visa to go to MSF’s reconstructive surgical hospital in Amman, Jordan. And then I need permission from Israel to leave Gaza for the treatment.

In Amman I will be able to have a bone graft, where surgeons will replace the missing bone by taking one from my ribs or leg.”

Eyad’s story

Twenty-two year-old Eyad was shot in the leg during the ‘Great March of Return’ demonstrations in Gaza on May 14 – one of the deadliest days witnessed by MSF teams in the six months of protests. He needs a bone graft and limb reconstructive surgery, which is not currently possible inside the Gaza strip. Eyad’s case has been accepted for treatment at the MSF’s specialist surgical hospital in Amman, Jordan — but for people living in Gaza, requesting the authorization to leave from the Israeli authorities is a lengthy, difficult process, which often ends with a refusal.

“I still remember vividly the day I was shot: the bullet entered my leg like an injection and then I felt a hot sensation on my other leg. I looked down and saw lots of blood, and I realized I had been wounded. I was in so much pain.

After the bullet entered my leg I started to shake, and it felt like I had electricity coursing through my body. At first, I was stunned by what I saw. I thought I was going to lose my leg and become an amputee.

I was shot on the 14 May 2018. Like a lot of Palestinians I was shot in the leg. It just goes to show how barbaric the Israeli army was toward us that day.

I went to the demonstrations because I love my country and I am trying to defend it. I wanted to show everyone that we have the right to our lands and the right to have our homes back. The demonstration was peaceful. Then the Israeli army started shooting. I knew it was going to be dangerous, so I went alone. I didn’t want to see any of my friends injured or killed. I wanted to free our land, our home, our sacred places. Israel can take all they want; I just want them to give us back our land.

My mother tried to convince me not to go and begged me to stay at home. She called my grandparents to try and persuade me. But they could not stop me. I had made up my mind.

I go to MSF’s clinic in Gaza three times a week for dressing changes and to have physiotherapy. My condition started to improve after the first debridement operation, which cleaned the gunshot wound and took out the infected blood. I have had about six operations, including the debridement of the wound, attaching the external fixator to stabilize the bone, and a skin graft where they took skin from my thigh to cover the gunshot wound.

The next stages of my treatment must be done in Jordan, at the MSF reconstructive surgical hospital in Amman. They plan to use a bone graft to fix the shattered bone, and a plastic surgeon will then reconstruct my damaged leg.

Dr. Mohammed Abu Mughaiseeb, MSF medical referent in Gaza

The last six months have been the most difficult I have experienced in my 15 years with MSF in Gaza. And that’s compared to the wars of 2008, 2012 and 2014.

For me, a doctor from Gaza, living and working here all my life, I feel like I know our limits in terms of what Gaza can endure. It’s been unbelievably difficult to tolerate the shocking volume of wounded arriving from the fence these last months. I will never forget Monday 14 May. The local health authorities recorded a total of 2,271 wounded in one day. This included 1,359 people injured by live ammunition.

I was with our surgical team at Al-Aqsa Hospital, one of the main hospitals in Gaza. At 3 p.m. we started to see an influx of patients coming from the demonstration. More than 300 wounded arrived though the doors in less than four hours. I had never seen so many patients in my life... Patients queuing to get into the operating theatre. The corridors were full; everyone crying, shouting and bleeding. No matter how hard we worked and how many we were, we could not cope with that many injured bodies. It was too much. Gunshot after gunshot. Our team worked for 50 hours supporting the Ministry of Health. It brought back the feeling of when we worked through the 2014 war. But really, nothing can prepare you for this.

And what are we seeing today? Still, each week new trauma cases arrive. The majority are young men with gunshot wounds in their legs with the potential to cause life-changing disabilities. The medical structures in Gaza are crumbling under the demand and ongoing shortages. MSF’s cohort of patients continues to grow and equates to about 40 per cent of the total gunshot wounded in Gaza, which now totals over 5,000 people. But the more we advance in treating these gunshot injuries, the more we see the complexity of what has to be done. It’s difficult, medically and logistically. A large proportion of MSF patients need specialized limb reconstructive surgical intervention, which means multiple surgeries for some patients, but the procedures are not currently possible in Gaza.

What terrifies me the most is the risk of infection. Osteomyelitis is a deep infection of the bone. If it goes untreated, it can lead to non-healing wounds and increase the risk of amputation. And as time goes on, it gets worse. These infections need to be treated as soon as possible. It’s terrifying to think they could lead to amputation for these young men. But the infection is not easy to diagnose and there is currently no structure in Gaza for analyzing bone samples to identify it. MSF is working to set up a microbiology laboratory here, providing supplies and training, in order to be able to test bone samples for osteomyelitis. But even then, once we are able to identify the infection, treatment requires a long and complex course of anti-biotic treatment for each patient and repeated surgical intervention.”

‘A question of medical ethics’

“I move all over the Gaza strip and I see young men everywhere on crutches with external fixators on their legs, or in wheelchairs. It’s becoming a normal sight. And so often they’re smiling and enduring life with their injury. But for me, as a doctor, I know the long term prognoses are bleak.

To talk to a patient, a young man, knowing that he could lose his leg a result of a bullet that has shattered his bone and his future, and to have him ask me ‘Will I walk freely again?’... This is very hard. Because I know, medically, due to the situation we are working in, he will struggle to walk again. And I have to pass the message that we will do our best, but the risks are high and there is a risk of him losing his leg. To tell this to a young man with his life ahead of him, that is very difficult. And it’s not just one patient — it’s a conversation we have to have many times with many patients.

Of course, we continue to try to find a way to treat these people within the limitations we face: overwhelmed hospitals and, because of the blockade, four hours of electricity a day, fuel shortages, depleted medical supplies, a lack of specialist surgeons and doctors, exhausted nurses and medics running the hospitals and not being paid their full salaries for months on end, restrictions on patients leaving Gaza to receive medical treatment elsewhere... The list goes on. And all around us we see the daily deterioration of Gaza. The social and economic situation has plummeted. Now you see children begging on the street; we didn’t see that a year or two ago.

MSF has a huge mountain to climb, and we cannot do it alone. We try. We push. We have to keep going. For us, it’s a question of medical ethics. These injured people must get the treatment they need. But from where I am standing, looking into the future is like looking into a dark tunnel. And the light at the end of the tunnel...I’m not sure it is there. It keeps flickering on and off.” — Al Arabiya English