As violence rages in Gaza, the number of injured people is soaring. Many are at risk of permanent disability.

Since October 7 and the escalation of violence between Israel and Hamas, some 29.000 Palestinians have been killed and 69.000 injured in the continuous bombing of Gaza by Israeli forces. This deadly offensive comes in the wake of a massive attack launched on Israel by Hamas, in which 1,200 Israelis were killed and 240 Israelis and foreign nationals were taken hostage.

All of HI’s efforts are now concentrated in Rafah, in southern Gaza, where 1,4 million people from northern Gaza were ordered to relocate and are now living in harrowing conditions without food, clean water and sanitation, without medicines or adequate shelter.

Reaching people in need - a major challenge

Against this backdrop of extreme violence, with telephone and Internet regularly unavailable, gathering information about people in need of help is a massive challenge.

Where it was once a matter of a simple phone call, HI’s teams are now informed of urgent needs by word of mouth or from partner organisations. Our social workers then take their cars and go either to the hospital or to the shelter where the person has taken refuge to speak with them directly. However, movements inside the Gaza Strip are limited due to the non-stop bombing and the physical barriers posed by the rubble and destruction. So, travelling by car - even just a few kilometres – is both difficult and dangerous.

Gathering essential information

When we finally manage to reach someone needing our support, we gather all the essential information. To get a clearer picture of their injury and for documentation purposes, we also use body mapping. On a body drawn on a piece of paper, we ask people to indicate where they are weak or in pain.

Since October 7, HI has assessed nearly 10 000 people - dozens of them have been amputated.

“ICRC told me recently that 70 to 80% of the people coming to hospital have been amputated or have spinal cord injuries. The numbers are huge. It is due to the type of weapons used,” says HI Rehabilitation Expert, Reham Shaheen. “HI alone has many people on its waiting list for assistive devices. Everyone is out of stock. Supply is our main challenge, along with security concerns about how to move between hospitals and shelters without being killed or injured.”

Reducing the risk of complications

Many people who have fled the violence and bombing have not received adequate medical care. Among them, a lot of have had an amputation.

Because of the collapse of Gaza’s medical system, the majority of amputees still have open wounds, untreated burns and fractures, and shrapnel in their bodies. Some of them even have shrapnel in their heads. Open wounds and severely damaged skin need dressing to prevent infection. Since October, HI nurses have dressed more than 2,200 wounds.

Whenever HI’s nurses dress wounds, our psychologists are there to provide support. Using different methods, they attempt to distract the patient, as there are no anaesthetics and it can be a very painful process.

2000 rehabilitation sessions in 4 months

Most of the injuries (fractures, spinal cord injuries, amputations and burns) need rehabilitation. Otherwise, the patient can develop stiffness in the affected limb that could lead to functional limitations or a permanent disability.

The situation today is chaotic. Many injured people are fleeing by car, horse or donkey carriage. They arrive in overcrowded shelters or hospitals with wounds that go untreated for days, causing life-threatening complications and infections.

“All the medical and rehabilitation teams in Gaza are overwhelmed by the situation and the lack of equipment and materials to treat patients properly. The humanitarian situation is no longer manageable. There are basically just two hospitals still functioning and thousands of injured people are waiting outside for treatment. There is no doubt that many injured people will end up with a permanent disability,” says HI Middle East Director Federico Dessi.

HI has provided 2,000 rehabilitation sessions in 4 months to injured and disabled people and has distributed 1,400 assistive devices, such as crutches and wheelchairs.

Challenges of offering physical rehabilitation in an active war zone

Normally, the objective of rehabilitation exercises is to prevent complications, maintain muscle function, and help improve mobility.  In times of peace, a minimum of seven emergency rehabilitation sessions are provided to meet the initial, urgent needs.

Today, the rehabilitation sessions have very basic objectives: in just three sessions we attempt to reduce complications, help the individual stand up or improve their balance and show them how to use an assistive device.

“People are constantly on the move, fleeing the violence and bombing, which makes any kind of follow-up extremely difficult. In this situation, we just do the best we can,” says Reham.

Thousands of prosthetics urgently needed

The prevalence of amputations and spinal cord injuries caused by the explosive weapons used in Gaza is unprecedented.

The waiting period after surgery is normally three to four months to allow the stump to be prepared for a prosthesis. In Gaza, the bombing and shelling have been going on for four months and most amputations are still too recent for prosthesis to be fitted.

For now, HI’s priority is to provide pre-prosthetic rehabilitation care, involving meticulous wounded dressing and physiotherapy to maintain the shape of the stump so that a prosthesis can be fitted at a later date.

“It is still too soon to fit prostheses and for post-fitting rehabilitation. The lack of medical personnel and essential supplies in Gaza is preventing the surgical interventions required to prepare the stump. In the context of war injuries caused by explosive weapons, multiple operations, including limb reconstruction and plastic surgery, are often needed. These procedures are currently unavailable in Gaza, and people will have to wait a long time for a prosthesis,” says Reham.

Call for an immediate ceasefire

HI continues to be alarmed by the very high number of civilian victims, the lack of safe humanitarian access and the limited number of trucks being able to enter the Gaza strip daily. Along with more than 800 organizations, HI is calling for an immediate ceasefire to put an end to the carnage and ensure the provision of humanitarian assistance to the affected population.

About HI in Palestine

HI launched its first project in Palestine in 1996. For the last 28 years, our teams have been responding to the needs of the Palestinian community – both in the West Bank and Gaza – across several sectors. HI Palestine is running projects in disaster preparedness and risk reduction, physical and functional rehabilitation, economic inclusion and economic recovery, and inclusive education. HI has also provided urgent humanitarian responses in situations of crisis.