The Head of Plastic and Reconstructive Surgery in Gaza, Dr Nafiz Abu-Shaban, reports in the British Medical Journal that the death and injury toll by sniper fire, as at 18 May, was 117 dead, including 13 children, and 12,271 injured, of whom 6,760 had been hospitalised, including 3,598 with bullet wounds. The numbers will be considerably higher by now.
Worse still, according to Medecins Sans Frontieres (MSF) who operate in Gaza, the Israelis have been using ammunition that causes fist-sized wounds of “unusual severity”.
In a press release dated 19 April MSF surgeons in Gaza report "devastating gunshot wounds among hundreds of people injured during the protests over recent weeks. The huge majority of patients – mainly young men, but also some women and children – have unusually severe wounds to the lower extremities. MSF medical teams note the injuries include an extreme level of destruction to bones and soft tissue, and large exit wounds that can be the size of a fist.
“Half of the more than 500 patients we have admitted in our clinics have injuries where the bullet has literally destroyed tissue after having pulverized the bone,” said Marie-Elisabeth Ingres, Head of Mission of MSF in Palestine. “These patients will need to have very complex surgical operations and most of them will have disabilities for life.”
She is reported saying that she hadn't seen these kinds of injuries before. The wounds appeared to be caused by ammunition with an expanding ‘butterfly’ effect.
"Mass lifelong disability now the prospect for young Gazans who merely gathered in unarmed protest"
Abu-Shaban says the hundreds of high energy compound tibial fractures from Israeli live fire are the most difficult of all open fractures to treat. They may require between 5 and 7 surgical procedures, each operation taking 3-6 hours. "Even with state-of-the-art reconstruction, healing takes 1-2 years. Most of these patients will develop osteomyelitis. A steadily increasing toll of secondary amputations is inevitable. They will also need intensive rehabilitation, but the only rehabilitation hospital in Gaza was destroyed by Israeli bombing in 2014 and has not been re-built. Mass lifelong disability is now the prospect facing Gazan citizens, largely young, who were merely gathering in unarmed protest about Israeli occupation and siege that has rendered their political and social futures impossible."
Reconstructing such injuries is far beyond the capabilities of Gazan medical services, now severely run down after 12 years of Israeli siege. Shifa is swamped and has no beds let alone the dedicated Limb Salvage Teams necessary for this work. Even London hospitals, which are fully resourced, would be stretched if confronted with mass casualties of this kind, says Abu-Shaban. "How are we here in Gaza to manage this situation? Why has no European government spoken out about events which if they had happened elsewhere would surely have been called an international outrage and probable war crime?"
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