Intended for healthcare professionals

Letters Health in Gaza

Gaza shootings: an orthopaedic crisis and mass disability

BMJ 2018; 362 doi: (Published 13 August 2018) Cite this as: BMJ 2018;362:k3295
  1. Nafiz Abu-Shaban, plastic and reconstructive surgeon
  1. Shifa Hospital, Gaza
  1. nafiz2000{at}

Further to Summerfield and colleagues’ correspondence on the situation in Gaza,12 I respond as head of plastic and reconstructive surgery in the country. The death and injury toll is still rising—as at 18 May, 117 were dead, including 13 children, and 12 271 injured. 6760 have been hospitalised, including 3598 with bullet wounds. Nineteen clearly identified medics have been shot.3

Médecins Sans Frontières (MSF) reports that people have been shot with bullets causing fist sized wounds of “unusual severity.” Marie-Elisabeth Ingres, head of MSF Palestine, says that “half of the more than 500 patients we have admitted in our clinics have injuries where the bullet has literally destroyed tissue after having pulverised bone.”4 I have not seen these kinds of injuries before. From the appearance of the wounds Israeli snipers seem to have used high impact military grade ammunition at relatively close range.

In June we had 300-350 high energy compound tibial fractures in Gaza. Complex lower limb injuries of this severity can require 5-7 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. The only rehabilitation hospital in Gaza was destroyed by Israeli bombing in 2014. Mass lifelong disability is now the prospect facing Gazan citizens, largely young, who were merely gathering in unarmed protest about Israeli occupation and siege. These are war crimes. There is now the question of an investigation by the International Criminal Court.

To reconstruct such injuries is entirely beyond the capabilities of Gaza’s already depleted medical services and requires dedicated limb salvage teams. If over 6000 injured patients, more than half with bullet wounds, required admission to hospitals in London over a short period of time, your services would also be stretched even though you are fully resourced.



Log in

Log in through your institution


* For online subscription