“[…] UNICEF estimates that a thousand children in Gaza have become amputees since the conflict began in October. “This is the biggest cohort of pediatric amputees in history,” Ghassan Abu-Sittah, a London-based plastic-and-reconstructive surgeon who specializes in pediatric trauma, told me recently. I met him in the waiting room of his plastic-surgery clinic on London’s Harley Street, and we walked to a nearby pub for a glass of water. Abu-Sittah, a fifty-four-year-old British Palestinian with an angular face and tender, deep-set eyes, has treated child survivors of war for the past thirty years in Iraq, Yemen, Syria, and elsewhere. […]
Abu-Sittah is the author of “The War Injured Child,” the first medical textbook on the subject, which was published last May. In October and November, he spent forty-three days in Gaza, conducting emergency surgeries with Doctors Without Borders. He shuttled between two hospitals: Al-Shifa and Al-Ahli, which is also known as the Baptist hospital. The casualty rate was so high that, during some intense periods, he didn’t leave the operating room for three days. “It felt like a scene from an American Civil War movie,” he said.
In Gaza, Abu-Sittah was performing as many as six amputations a day. “Sometimes you have no other medical option,” he explained. “The Israelis had surrounded the blood bank, so we couldn’t do transfusions. If a limb was bleeding profusely, we had to amputate.” The dearth of basic medical supplies, owing to blockades, also contributed to the number of amputations. Without the ability to irrigate a wound immediately in an operating room, infection and gangrene often set in. “Every war wound is considered dirty,” Karin Huster, a nurse who leads medical teams in Gaza for Doctors Without Borders, told me. “It means that many get a ticket to the operating room.”
To mark the gravity of these procedures, and to mourn, Abu-Sittah and other medical staff placed the severed limbs of children in small cardboard boxes. They labelled the boxes with masking tape, on which they wrote a name and body part, and buried them. At the pub, he showed me a photograph he’d taken of one such box, which read, “Salahadin, Foot.” Some wounded children were too young to know their own names, he added, telling the story of an amputee who’d been pulled from rubble as the sole survivor of an attack.
The number of child amputees carries long-term implications, Abu-Sittah told me, listing his concerns. Israeli forces destroyed Gaza’s only facility for manufacturing prosthetics and rehabilitation, the Hamad hospital, which was inaugurated in 2019 and funded by Qatar. The leading manufacturer of child prosthetics, the German company Ottobock, is working to supply the necessary components to children up to the age of sixteen, with donors in place to fund the project through its foundation. Procuring prosthetics, however, is only the first step. “Child amputees need medical care every six months as they grow,” Abu-Sittah said. Because bone grows faster than soft tissue and severed nerves often reattach painfully to skin, child amputees require ongoing surgical interventions. In his experience, each limb requires eight to twelve more surgeries. To track this cohort, Abu-Sittah is consulting with the Centre for Blast Injury Studies at Imperial College London and the Global Health Institute at the American University of Beirut; their goal is to create a cloud-based database of medical records that can follow these kids wherever they go. For the rest of their lives, these amputees will need answers regarding their medical history. Abu-Sittah knows how this works: for years, as a pediatric trauma surgeon, he’s fielded calls from his former patients.
Abu-Sittah, who’d recently travelled to Qatar to consult, recalled meeting a fourteen-year-old boy who’d lost his leg after being trapped under rubble. He’d spent a day beneath the debris holding the hand of his dead mother. “These are vulnerable people in the midst of the storm,” he said.
[…] For separated families, as well as for those trapped in Gaza, the mental-health toll of the crisis continues to mount. During the first several months of the conflict, the Gaza Community Mental Health Programme (G.C.M.H.P.), the leading mental-health organization in the Strip, ceased operations. Two weeks ago, in Rafah, they re-started some of their programs. “We can’t wait any longer for a ceasefire to take place to deal with mental health,” Yasser Abu-Jamei, a psychiatrist and the head of the G.C.M.H.P., told me by phone from Rafah recently. Abu-Jamei is also displaced and living in a tent in Rafah. He and a team of mental-health providers go into camps to speak to families and perform psychological first aid. They work with traumatized children, trying to help them identify somewhere nearby that’s safe. “If we can’t find an actual place, we help children imagine somewhere safe,” he said. They also work with parents who are baffled by their children’s misbehavior, and, with the help of the World Health Organization, they provide psychotropic medications to adults—though such drugs, like most others, are scarce. […]
For children who’ve experienced extreme loss, such hypervigilance is common, Salsabeel Zaeid, a psychologist working with children and families at the compound, told me. Many of the child amputees in Doha suffer from “depression, anxiety, trouble concentrating, restlessness, nausea, trouble sleeping, anxiety attacks, hopelessness,” she said. “They’re really tearful and guilt-ridden,” she added. The children suffer from a form of survivor’s guilt, because, unlike friends and family members, “they’ve walked into another country and their basic needs are being met.”
Ridana had taken Gazal to the compound’s mental-health clinic to see whether Gazal might benefit from speaking with a therapist. But, at the appointment, Gazal broke down, crying the whole time and telling her mom to answer the questions. “It caused her more pain,” Ridana said. She recalled what the therapist told her about attachment: that maternal bonding was integral to Gazal’s ability to heal. Ridana said, “For now, what she needs is her mom by her side.”“