Limb reconstruction surgery, Gaza

IDEALS trauma care programme in Gaza:

  • We have been active in Gaza since 2009; intensively since the 51 Day War in 2014.
  • Our principal objective: to improve the management of adult and paediatric trauma, including complex limb injuries, through a combination of treatment, training, capacity building and the procurement of essential equipment/consumables.
  • Subsidiary objectives: to reconnect Palestinian surgeons and allied health professionals to the wider world, excluded by siege since 2007; and to promote the ortho-plastic approach (orthopaedic and plastic/reconstructive surgeons working closely together) to the management of trauma/complex limb injuries.
  • How we do this:
    • Close coordination with the health authorities in Gaza, UN agencies (primarily the World Health Organisation (WHO)), International Committee of the Red Cross (ICRC), other international NGOs active in trauma care and clinical colleagues in Gaza’s hospitals.
    • Regular visits, up to eight per year since 2014 (interrupted only by the COVID-19 pandemic), by teams of volunteer NHS orthopaedic and plastic surgeons, nurses, physiotherapists and radiographers.
    • Visits supplemented by weekly/fortnightly videoconferences, email and WhatsApp communication.
    • Seven training fellowships for Palestinians in UK trauma/limb reconstruction centres (three surgeons, two nurses and two physiotherapists): four more planned, two imminently.
  • Our long-term support has brought about:
    • Capacity for the management of the most severely wounded where formerly there was none.
    • Reduction in the numbers of wounded transferred out of Gaza for treatment.
    • Significantly improved outcomes for patients: better quality of life; less pain; and able to do more of the routine tasks we all take for granted.
    • Acceptance and welcome by patients, clinical colleagues and health authorities alike.

Current Crisis

The conflict in Gaza began on 7th October 2023. As of the evening of 21st February 2024:

  • 29,313 Palestinians in Gaza have been killed and 69,333 injured. Women and children, tragically, make up 70% of all those killed to date.
  • Many people remain missing, presumably buried under the rubble, waiting for rescue or recovery.
  • Heavy bombardments across Gaza from air, land and sea are ongoing, with intense ground operations and fighting between Israeli forces and Palestinian armed groups, especially in Khan Younis and Rafah.
  • On 12th February, the UN High Commissioner for Human Rights, Volker Türk, warned that a “potential full-fledged military incursion into Rafah – where some 1.5 million Palestinians are packed against the Egyptian border with nowhere further to flee – is terrifying, given the prospect that an extremely high number of civilians, again mostly children and women, will likely be killed and injured. There must be an immediate ceasefire. All remaining hostages must be released. And there must be renewed collective resolve to reach a political solution.”
  • Only 12 of 36 hospitals across Gaza are partially functional and able to admit patients. In Khan Younis, remaining patients and staff are slowly being evacuated from Nasser hospital, and the European Gaza hospital is at risk of closure due to the issuance of evacuation orders in adjacent areas and the ongoing conduct of hostilities nearby.
  • Over 80% of primary health care clinics have shut down because of damage or a lack of fuel and/or staff. This severely compromises access to health care for everyone, but particularly young children, pregnant and breastfeeding women, older persons, persons with disabilities and patients with non-communicable diseases (NCDs).
  • Only four of 22 United Nations Relief Works Agency (UNRWA) health centres are still operational in southern areas of Gaza. Midwives are providing care for post-natal and high-risk pregnant women at these centres, with an estimated 50,000 pregnant women in Gaza and more than 180 giving birth every day in the most appalling conditions.
  • 1.8 million Palestinians have been displaced from their homes, fleeing to emergency shelters or the homes of family/friends, with many now displaced multiple times.
  • A severe water shortage, consumption of contaminated water, massive overcrowding in shelters and breakdown of the vaccination programme have already resulted in a surge in communicable disease reports, with cases of diarrhoea, respiratory tract infections and hepatitis A rising rapidly. There has also been a concerning increase in the number of cases of mumps and meningitis.
  • Catastrophic levels of acute food insecurity are intensifying across Gaza and the Global Nutrition Cluster has reported a steep rise in malnutrition among children and pregnant and breastfeeding women. The situation is especially serious in northern Gaza where 1 in 6 children under the age of two who were screened at shelters and health centres in January were found to be acutely malnourished; a rapid decline in the population’s nutritional status that is unprecedented globally.
  • Mains electricity has been unavailable since 11th October 2023, with completely inadequate fuel supplies for emergency generators, even at hospitals.
  • Erez crossing remains closed by the Israeli authorities. Rafah and Kerem Shalom crossings are now open more consistently, allowing a small number of internationals and critically injured patients to leave and the delivery/distribution of aid into Gaza, but still only a fraction of the fuel, food, water and medical supplies needed are getting in.

Our immediate objectives:

  • To help respond to the current emergency, getting surgical teams and life-saving equipment/supplies into Gaza as soon as possible. Our first team worked at the European Gaza hospital, Khan Younis, for two weeks from 27th December 2023, our second team have just returned from a fortnight at the same hospital, and our third team travel out at the end of February. We have been able to support local colleagues, exhausted and fearful for their families, with the emergency surgical management of survivors of major trauma (predominantly blast and crush injuries), and the subsequent management of patients with complex limb injuries. So many of these patients have lost family members and have devastating, disabling wounds, requiring multiple operations and lifelong rehabilitation.
  • To simultaneously complete a thorough assessment of health care needs in Gaza to guide our subsequent work.

Medium-term objectives:

  • To continue support for the established adult/paediatric trauma and limb reconstruction services, to ensure resilience and robust succession planning.
  • To bring standards of major trauma care at the five principal hospitals up to modern international standards.

To support our vital work please donate through the link above. Thank you.

Limb reconstruction clinic, Gaza

Typical surgical instrument set

To read a case study that really highlights the value of the limb reconstruction service click here

Other Projects Completed in Gaza Over the Past 14 Years:

  • Established Primary Trauma Care courses in Gaza; delivered the initial training courses and trained local trainers within the Ministry of Health to ensure sustainability
  • Difficult airway management training - particularly important in major trauma
  • Further training in trauma care for first responders (paramedics)
  • Associated with evidence based medicine development in Gaza
  • Water quality - provided the public health service in Gaza with the equipment and training needed to monitor the quality of drinking water; both routinely and during emergencies
  • Supported improvements in theatre practice/hygiene and hospital sterilisation services
  • Supported the National Society for Rehabilitation with: an upgrade for their mobility aid repair/maintenance workshop; and the purchase of five Braille computer-speakers to allow those with visual impairment to utilise the computer laboratory
  • Funded the addition of an occupational therapist to the multidisciplinary team at Al Asdiqaa Association; a local NGO that runs a community based rehabilitation programme for persons with disability in Rafah, south Gaza