Thursday 17 October 2019

'Around 30 boys are shot every Friday' - An Irish anaesthetist on trying to dull the pain in the war zone of Gaza

 

A protester at the Israeli border. Photo: Anadolu Agency
A protester at the Israeli border. Photo: Anadolu Agency

Francesca Holt

'Sagheer' - meaning young boy in Arabic - is 16. His curly brown hair is piled high and shaved short around the sides.

Every second day, Sagheer cries as dressings are pulled from the crusted pus and blood that seeps from his lower leg.

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One Friday, four months ago, Sagheer was shot in the leg by the Israeli military as he threw rocks across a fence. That fence is the land crossing controlled by Israel, which keeps two million people inside Gaza, on a 41km-long strip of land.

The Israeli authorities also control the maritime space and sky, allowing the Gazan people to fish only 15 nautical miles out from the shoreline, lining this oceanic perimeter with gunboats.

Surgeons working on a patient. Photo: Jacob Burns
Surgeons working on a patient. Photo: Jacob Burns

The sky above Gaza is peppered with both stars and Israeli drones.

Friday, March 30, 2018 was the first mass demonstration against 11 years of blockade in Gaza. Since that Friday, more than 7,500 Palestinians have been wounded by Israeli live fire.

Every Friday since then, young boys like Sagheer have gone to the fence that pens them in from the rest of the world, to protest.

Then they are shot. Every single Friday. In August, the numbers dwindled; around 30 boys are shot, every Friday. This is not considered war. This is just what happens in Gaza, every single Friday.

I am a paediatric anaesthetist and I spent the last month working on an orthoplastic limb salvage project in Gaza. Médecins Sans Frontières (MSF) has responded to the health crisis created by these shootings. Multi-disciplinary teams are trying to salvage these young men's legs.

Live bullets cause such destruction to the bone that they mushroom inside and obliterate the structure, causing gaps that have to be filled with cement. I heard the term 'bone-gap' more often than I hear the word allergy or asthma, at home in Ireland.

An X-ray showing the damage to another sniper victim’s leg. Photo: Jacob Burns
An X-ray showing the damage to another sniper victim’s leg. Photo: Jacob Burns

The risk of bullet fragmentation is higher if the ammunition reaches the knee joint. The bullets that hit Sagheer, (there were two), did not affect his joint. A sniper fired directly into his tibia.

Of all injuries, 80pc are to the lower limb, maiming the future generation. I saw patients with tear gas canister shells embedded in their cheekbones but the head injuries and chest trauma were taken to non-MSF hospitals. I did not see any of the 209 people who have been killed by the Israeli military during demonstrations since March 2018. I looked after their families and their friends and I heard Sagheer cry for his dead brother.

Sagheer's leg is rotting. He, like many others, suffers from chronic infection inside his bone.

We need to identify the specific organisms dragged into the wound from the cavitating path of the bullet, so that Sagheer's antibiotics are targeted and do not create a milieu of resistance. Bone biopsies are sampled from the wound. During my mission, these samples were taken through checkpoints at the land crossing, into Israel, for analysis.

The waiting room at the MSF clinic. Photo: Simon Rolin
The waiting room at the MSF clinic. Photo: Simon Rolin

Thankfully a laboratory with capacity to analyse bone samples has been set up by MSF, reducing the risk of contamination that a journey through Israeli security can entail. Results are released around 10 days later. Sometimes I predicted what pathogen we were dealing with, from the smell on the ward.

Sagheer describes the shooting pain that radiates into his foot, as "electrical". Amputating his leg is unlikely to stop this feeling. It might prevent the infection from overwhelming his system, in the form of sepsis, many Fridays after he was shot.

As an anaesthetist, part of my role is to provide pain relief for my patients. When I first met Sagheer, I suggested that I would provide a nerve block for debridements and thereby avoid the drowsiness that accompanies emergence from general anaesthesia. With a teenage nod, he nonchalantly agreed.

What I had not anticipated was the psychological trauma Sagheer felt when people touched the remains of his precious leg. As the surgeon began to unwrap the dressings, Sagheer started to cry. Within five minutes he was howling for his "mama" and for his younger brother, who had been killed. This child was so upset I had to sedate him for every subsequent procedure.

As a result of the injuries during mass demonstrations, 148 limbs have been amputated including those of 30 children.

The clinic is filled with young men on crutches, with external fixators scaffolding the precious remnants of their tibia or fibula together.

We have sent specialist reconstructive surgeons, infectious disease doctors and physiotherapists to support the national staff in a bid to ensure these young men can stand up again.

For the majority, that chance is small. Even if we can rebuild their bone and muscle and rid their system of bacterial colonisation, strength to stand up isn't solely physical.

In reality, many of these young men will lose their legs because they stood up for freedom. Last Friday, 29 people were shot with live ammunition.

Young men, like Sagheer, stand up and are shot down. Every single Friday.

Francesca Holt is an Irish anaesthetist who has just returned from working in Gaza for Médecins Sans Frontières/Doctors Without Borders (MSF)

Irish Independent

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