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Piecing the injured back together

Eva Bartlett | Inter Press Service

10 August 2009

Following consultation with him and with the specialist in prosthetics and orthotics rehabilitation from the International Committee of the Red Cross (ICRC), many will begin the long road to treatment.

“It was the second day of the war,” says Omar Al-Ghrub (24), referring to the three weeks of Israel attacks in the winter of 2008-2009. “I was working that day,” he said. By day he worked in the Al-Waleed marble and granite factory northwest of Gaza city, and by night served as its watchman.

A missile struck, and Ghrub lost both his legs. Six months later, he waits for the stumps to heal enough to begin the process of fitting artificial legs, and learning to walk anew.

Loay Al-Najjar, 22, also lost both his legs. At 11 pm Jan. 13, Najjar was trying to help his sister evacuate a house that had been hit by shelling in the Khoza’a region, east of Khan Younis. “I was hit by a drone missile,” says Najjar. His legs were lacerated with shrapnel. But he is one of the luckier ones; he was able to travel to Saudi Arabia where he received treatment for three months, and artificial legs.

Ghrub and Najjar are among the many waiting for a consultation this particular Saturday. The artificial limb centre is unique in that it makes and fits the limbs on the premises. With the help of staff from the ICRC and Doctors Without Borders (MSF), it also provides physiotherapy and other support.

The centre is overcrowded – it is the only one of its kind. The waiting list has lengthened dramatically since the Israeli attacks on Gaza. Gaza’s Ministry of Health says between 120-150 new patients have had to have amputations following the Israeli attacks on Gaza. Gerd Van de Velde, head of the ICRC’s physical rehabilitation team in Gaza, says the number could rise with patients whose wounds worsen.

“Even now we are getting new patients,” says Van de Velde. “Some patients are having problems with their stumps as they were not cared for properly during their initial treatment due to the hectic situation. At the time, treatment was focussed on life-saving.”

In January 2008, five to ten patients came on a Saturday; now there are at least 30. ICRC figures show that in 2008, 63 patients received 71 prosthetic limbs (some had multiple amputations), and the centre served 1,500 patients. In the first half of 2009, 1,018 patients have come to the centre, 53 for prosthetic limbs.

“We have 146 patients on the waiting list, including 101 with war wounds,” says Van de Velde. “Of these, over 50 percent are above the knee amputations.” Blast injuries become even more complicated, because shrapnel must be extracted from the stump of the limb before it can heal enough for prosthetics treatment.

A few years ago, the centre used its funding to pay all the costs of the materials. Nearly all came from a specialist company in Germany, some were bought at twice their usual price from an Israeli importer.

Now, the ICRC, which began working with the centre in November 2007, supplies most of the materials, buying directly from the manufacturer, and also facilitating transfer through Israel. The centre also gets help from the United Nations Relief and Works Agency (UNRWA), Handicap International and Islamic Relief.

Van de Velde sees early hospital care, or the lack of it, as the origin of the problem for many of the patients. In a crisis, he said, “patients are evacuated quickly to make room for new patients. They did not receive the treatment and follow-up physiotherapy that they needed.”

The ICRC has now taken on a second, hospital-based project. “We’ve started with Shifa hospital, and hope to expand to Gaza’s other hospitals, focussing on quality of post-surgical physiotherapy care and ensuring that patients receive the treatment that they need.” Likewise, MSF is working throughout the Gaza Strip to provide post-operation wounds care and physiotherapy.

At the artificial limbs centre, taking a pause from casting and sculpting limbs, Nabil Farah and Mohammed Ziada, two of four specialists in prosthetics, take turns to demonstrate work at the centre. The specialists have both studied abroad, in Germany and in India, and want the trainees here to be sent for specialised studies. But with the siege on Gaza and the sealed borders, it has become difficult to leave Gaza.

Likewise, says Farah, many specialists want to come to Gaza to train technicians in making and working with prosthetic limbs, but they cannot enter because of the siege. But on Jul. 1, after much coordination with the Israeli authorities, the ICRC was able to send two Palestinians to India for an internationally recognised 18-month training programme. Van de Velde says the ICRC plans to send three more to be trained next year, with the aim of building a pool of qualified technicians.

All sorts of people were injured in the last assault. “During the first and second Intifadas (Palestinian uprisings, 1987-1991 and then from September 2000), most of the injuries were among the shebab (young men),” says Mohammed Ziada. “But in this last war, most of the injuries were people other than shebab: elderly, children, women…”

While the current focus is on people injured in the assault, the artificial limb centre also tackles birth disabilities. “Each month we normally make 20 to 30 braces for straightening legs,” says Farah. “This cures more than 80 percent of patients.”

Farah points to several siege-related difficulties the centre faces. The artificial limb centre uses hundreds of different parts, plastics and materials to make the prosthetic arms and legs. “Without even just one of the materials, the limb cannot be made. We don’t have the materials or the chemicals in Gaza to make the limbs.” Israel often prevents or greatly delays materials from entering, says Farah.

Walking through a storage room, Farah points out various empty shelves. Among clusters of different weaves of stocking net cloth used in the making of limbs, size 10 shelf sits empty. “We haven’t had size 10 for the last month,” Farah says.

Also absent are artificial foot parts L23, unavailable for the last 10 days, and R24 and R25, depleted for the last two months. “We help first those who need help the most,” says Farah.

Gerde Van de Velde says, however, that “not one patient had to wait because of a lack of material.” Items like the cloth can be substituted by a closely related size, he says. He admits there are restrictions on certain chemicals, but adds that these are more related to international law, and delayed by other bureaucratic procedures regarding the transport of chemicals.

Farah cites some sample costs: a below-the-knee prosthetic is about 800 dollars. An above-the-knee limb is twice as much. An arm costs 1,200 dollars. Yet these seemingly expensive limbs cost a fraction of what they might in other countries.

“Our salaries are very low,” says Farah. “We aren’t working for the money, obviously. We’re working for the many Palestinians who need limbs and therapy.”