Tuesday, November 24, 2020

Wounded by Israeli forces: the devastating costs of injury

By J.J. Rhies - April 27, 2019
Section: [Main News] [Features]
Tags: [Gaza] [medical supplies]


Last October, Rami Abu Karsh, 41, was standing on the shores of Zikim, a beach in northern Gaza, at a “Great March of Return” protest when Israeli forces shot him in the leg with live ammunition.


“[I]t was an explosive bullet,” Karsh, a father of six, said. “It completely destroyed the right thigh bone and the nerves. The diameter of the wound was about 20 centimetres.”


Bleeding “intensely,” he was rushed to Indonesia Hospital north of Gaza City, where doctors saved his life. His haematocrit blood level, which is a measure of the volume of red blood cells in blood, was 5 per cent, he said. The average haematocrit level for men is 40 per cent.


According to a World Health Organisation (WHO) report in March, 6,622 Palestinians have been wounded by Israeli live ammunition since the “Great March of Return” demonstrations began more than one year ago. Of those, 87 per cent - or 5,244 - were shot in the lower limbs. 110 leg amputations have been done since then.


The demonstrations, which happen every Friday along the Israel-Gaza perimeter fence, began on March 30, 2018, as an organic, population-wide response to Israel’s blockade of Gaza. Since 2007, Gaza’s economy has been on the brink of collapse, and Israel has conducted three major military operations, killing thousands of Palestinians and razing a large portion of residential and commercial infrastructure.


'No adequate treatment for the injured’


Marie-Elisabeth Ingres, head of the Mission in Palestine for Doctors Without Borders, a medical humanitarian organisation, said the Israeli blockade and intra-Palestinian political conflict hinder the efficacy of Gaza’s healthcare system. Medical centres do not have the resources necessary to treat thousands of Palestinians at once, according to her.


“We don’t have enough beds, we don’t have enough drugs, we don’t have enough [medical] consumables … . [T]here is no adequate treatment today for the injured people.”


Before Karsh was shot, he was a salesman and an active member of his community. He helped lead the Scouts for Gaza, which is similar to the Boy and Girl Scouts, and organised summer camps. He also worked overtime in order to afford the health treatments of his daughter, who has heart problems.


In the wake of his injury, he spent two months in hospitals, receiving anaesthetics and undergoing three major surgeries. Doctors estimate it will be more than a year before he regains some of his pre-injury mobility.


Since being discharged in February, he stays “in a room on a bed all day,” unable to work. One week per month, he leaves the house for outpatient medical consultations. Compared to many care-seeking Gazans, Karsh has been very fortunate.


Mahmoud Shalabi, the Gaza program manager for Medical Aid for Palestinians, said “for years” there has been a lack of crucial medical consumables (such as bandages, ointments and medications), which sometimes prevents doctors from being able to operate on wounded or recovering patients.


“Currently, ... approximately 48 per cent of ... essential and life-saving medications ... do not exist at the [Palestinian] Ministry of Health [in Gaza] or are at a stock of less than one month’s supplies,” Shalabi said, referring to March 2019 findings from the United Nations Office for the Coordination of Humanitarian Affairs in the occupied Palestinian territory (OCHAOPT).


On average in 2018, 47 per cent of essential and life-saving drugs had less than a month’s stock, according to the OCHAOPT report - a 9 per cent increase from the 2017 average.


“Even if the medical expertise inside of Gaza was able to do these surgeries ... , they don’t have the proper equipment, disposables and drugs to do them.”


Despite Karsh’s relative luck, having successfully received medical care, life has been difficult for him and his family since the injury. His treatments have been paid for by the Palestinian Authority and Israel, and his family is also a long-time recipient of aid, reserved “for the poorest families,” from the United Nations Relief and Works Agency for Palestine Refugees in the Near East. But the indirect costs of healthcare - such as transportation to and from appointments - combined with a protracted recovery that prevents him from working, have exhausted the family’s savings, he said.


When Karsh spoke to Palestine Monitor on April 18, he said it had been four days since their home had had gas for the oven. And only two days prior, on April 16, the only food in the house was bread.


Karsh said being in recovery has also impacted his mental state and relationships with his family. He said he and his wife have considered getting a divorce several times since October.


“My relationship with my children has ... deteriorated because I keep pushing them away … . But the situation was the complete opposite in the past,” he said.


“I used to hug them all the time and play with them.”  


Sidestepping Gaza’s overburdened healthcare system


Even if doctors in Gaza always had the medical resources they needed, Ingres said, it is not likely all injured patients would receive adequate medical treatment.


“[W]hat’s happened in the last year in Gaza is impossible to manage in [its healthcare system] or anywhere in the world ... . Even if it was a normal health system ... it would be very difficult.”


Gaza’s medical centres are flooded with “thousands of people with exactly the same type of injury at the same moment,” which means that a high number of doctors with the same specialty are needed, she added.


Due to the obstacles faced by Palestinians seeking care in Gaza, thousands apply each year for medical permits to receive treatment outside the territory - either by way of the Erez crossing, to Israel and the West Bank, or the Rafah crossing, to Egypt. The bulk of applicants apply to cross through Erez. All applications must be approved by both Palestinian and Israeli authorities.


Shortly after his injury, Karsh was granted a medical permit to receive treatment in Egypt, but he cannot afford the operation and is waiting on external funding.


The Israeli Coordinator of Government Activities in the Territories (COGAT), a unit of the Ministry of Defence, told Palestine Monitor in an email statement that Israel grants medical permits when health treatment could be “life-saving or where the absence of treatment would significantly harm the patient’s quality of life.” COGAT said it was committed to assisting care-seekers even though “Hamas and the other terror organizations ... abuse the exit of patients who seek life-saving medical care.”


“[E]ach such request is evaluated individually on its merits, in conjunction with all the appropriate professional offices, according to the relevant considerations and humanitarian situation.”


“Although Israel has no responsibility for the Gazan health system, ... COGAT issued more than 33,000 permits for the purpose of medical care in 2018,” the statement added.


WHO has documented a steady annual decline in the number of medical permits issued by Israel in recent years: In 2017, the state granted permits to 54 per cent of applicants, the lowest figure between then and 2008, when WHO started collecting data.   


Between March 2018 and February 2019, Palestine Monitor found that 62 per cent of Erez crossing applications were accepted, according to data aggregated from monthly WHO reports.


During that same period, which was the first year of “Great March of Return” protests, 499 injured demonstrators applied for medical permits, Shalabi said. 18 per cent were accepted, 28 per cent were declined, and 54 per cent were delayed. He said that applicants who are delayed may wait “forever” for a response.


In 2017, 54 Palestinian permit-seekers died after Israel delayed or denied their applications.

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