Israel’s war on Gaza has injured more than 150,000 Palestinians. Many with life-changing injuries need specialist long-term care, but face devastation and blockade by Israel. What’s the impact of all this on Gaza’s people now and into the future? This is Inside Story.
Hello, welcome to the program. I’m Adrian Finighan. A grim statistic has been reached in Gaza. The number of people injured in Israel’s war has surpassed 150,000. The pain of grief for the more than 60,000 people killed since October 2023 will be endured by many. But coping with the huge numbers injured brings a new burden to Gaza’s people.
Caring for the wounded, many with life-changing injuries, presents mammoth challenges. Israel’s targeting of medical staff and facilities deprives the huge numbers of casualties of the expertise and equipment needed. The psychological impact of the war on Gaza’s people is incalculable. Another burden they must bear. The consequences of Israel’s genocide will last well beyond this generation. So, what does all this mean for Gaza now? How can its people cope with such challenges? And what’s the role of the international community? We’ll get to our guests in just a moment. But first, this report from Felix Noara:
“Home to the world’s largest group of child amputees in modern history.” That’s how UN officials began describing Gaza in October last year, and the situation is worsening.
Gaza’s health ministry says more than 150,000 Palestinians have been injured or wounded since Israel began its war. 18,500 will require long-term rehabilitation: Among them are at least 4,700 people who have had one or more limbs amputated. And it’s not just the devastating physical injuries. The mental trauma will need complicated and long-term care: “Recovering from an extensive injury or attending physical rehabilitation process requires an enormous amount of psychological strength. Many people in Gaza have been made more vulnerable than before by this conflict especially the persons with disability who require special dietary systems who require their provision of proper prosthetics who require transportation means to attend physical rehabilitation sessions and physiotherapy sessions.”
Gaza’s war-ravaged health system often means that proper care can only be obtained abroad. But medical evacuations too have been marred in layers of bureaucracy and delays: “We submit their names for evacuation to the WHO, which has been doing an amazing job evacuating kids out of Gaza to different countries and organizations. Once they’re approved by the WHO, they submit their names to the Israeli authorities who then either approve or disprove the patients. Up until recently, most of the kids were not being permitted to travel. Once they’re approved by the Israelis, we have to get them also approved by the Jordanians or the Egyptian authorities. And then they have to obviously get visas by the American embassy in either Cairo or Aman. That’s just to get them to a place where they can then get on an airplane and travel for medical care.”
The UN says nearly 7% of people across the Gaza Strip now suffer lifelong physical limitations. Many of them have been children wounded with no surviving family.
Felix Noara Aljazeera for Inside Story.

Presenter, Adrian Finighan:
Let’s bring in our guests from Gaza City. We’re joined by Dr. Khamis Elessi, Neurorehabilitation and Pain Medicine Consultant at Al Ahli Arab Hospital in Gaza.
From Perth, we’re joined by Dr. Safah Jabr, a Palestinian psychiatrist and psychotherapist and former Head of the Mental Health Unit at the Ministry of Health in Palestine. She’s currently on tour in Australia to promote her latest book, Radiance in Pain and Resilience: The Global Reverberation of Palestinian Historical Trauma.
And from Beirut, we’re joined by Dr. Ghassan Abu Sittah who has served as a war surgeon in Gaza, Lebanon, Syria, and elsewhere in the Middle East. He’s a professor of conflict medicine at the American University of Beirut. A warm welcome to you all.
Dr. Khamis, let’s start with you. The numbers here are beyond belief, aren’t they? 150,000 injured or wounded, 18 and a half thousand in need of long-term rehabilitation. Nearly 5,000 who’ve had one or more limbs amputated, 7% of the entire population in Gaza suffering from a lifelong physical limitation. Given the collapse of Gaza’s health care system, how many of those people will go on to die without further urgent medical care?

Dr. Khamis:
First of all, thank you Adrian for having me in your show and thanks for my co- guests here in this show. If you speak about the numbers here in Gaza, even prior to the war, the health care system here in Gaza City and Gaza Stripped at all was crumbling. It was facing lots of challenges, lots of difficulties, lack of essential medicines, lack of infrastructures, lots of equipments that is not function properly. And now since the October 7th until this moment, as you’ve mentioned, we have more than 150,000 injuries. out of them the numbers now show more than 20,000 or even 23,000 needs long-term rehabilitation. Unfortunately, those people who needed rehabilitation if not given the rehabilitation at the right time in the right place in the right care system. They will face lots and lots of complication and many of them will die of preventable complications like chest infection, wound infection and even complication of spinal cord injures like autonomic dysreflexia and other reasons. So those population are the target of not only rehabilitation but they need other healthcare intervention like managing their diseases their fractures and their malnutrition status. So, it’s a multitude of problems that we are facing with those patients.
Unfortunately, with lack of facilities, lack of infrastructures and lack of prosthesis really to fit those 4,700 persons with amputations put us in a real challenge. Who in the world will go and treat those patients? Just prior to the war, we have two centers who offer rehabilitation here in Gaza City and they have a bed capacity of around 100 inpatients and almost 100 outpatient clinics. But now with this huge unprecedented numbers of persons with long-term rehabilitation needs, they need more than one center. Unfortunately, now we have only one center which is currently functioning with limited resources and limited facilities and limited personal qualified personnel.

AF: All right.

Dr. Khamis: So, we really need to act and act now before it’s too late.

AF: Yeah. Let let’s bring in Dr. Samah. What do we mean when we talk about rehabilitation? What exactly do people need? I mean, oh, they’re all going to need something different, aren’t they?

Dr. Samah:
Well, people need physical rehabilitation but also psychological rehabilitation because many of those who are severely injured and they have they suffer from limitations, they will also suffer from psychological consequences that are less visible. And yet there are many other people whose wounds are completely invisible. They suffer a lot from grief. They suffer from trauma, traumatic consequences, from the destructuring of the social fabric around them. There are many parentified children in Gaza, many young people who shoulder the responsibilities of adults and it’s very difficult to live for a long time with these responsibilities. This will interrupt their normal development and their childhood and there will be repercussions in the future. So the word rehabilitation is much larger than the physical rehabilitation. It includes establishing a functional mental health system in Gaza now. But it is very difficult when there is no safety with without a safe place. It’s really difficult to have um reasonable and effective contribution to the field of mental health in these challenging times.

AF: Dr. Ghassan, tell us about your experiences of working in Gaza and under what conditions were you were you operating? Were infection prevention systems working? Was lighting adequate? Did you have adequate support in in in theater anesthesia?

Dr. Ghassan:
So we need to think about this number of 4,700 amputees as the tip of an iceberg. From the very beginning from October November 2023 the number of wounded so overwhelmed the health system that non-life-threatening limb injuries rather than go to the operating room within 24 to 36 hours as is the recommendations in war injuries were not going to the operating room for a week 10 days sometimes which meant that these open fractures in these limbs could get infected much easier. As Israel systematically destroyed the health system, it meant that these injuries were left untreated with open wounds and open fractures. And so the number of salvageable limbs became less and less and people who ended up with amputations in salvageable limbs increased because eventually when they would get to the operating room, infection would set in, bacterial infection to the long bones would set in. And so at some stage at the end of October 2023 into no into 2024, our colleagues were saying that half of the amputations that they were performing were on limbs that they knew they would otherwise have been able to save.
We now have a situation where people are so malnourished that these injuries also are unable to heal. Which means that now an added pressure on previously salvageable limbs becoming h infected and moving towards amputation. And so we’re looking at rather than 30% of these complex limb injuries ending up with an amputation eventually, you’re looking at closer to 60 to 70% of any limb injury in Gaza needing an amputation eventually because the system has collapsed and people’s physiology has collapsed as a result of the malnourishment.

AF. I wanted to ask Dr. Khamis about this lack of adequate nutrition and the spread of infectious diseases that Dr. Ghassan was talking about there and what impact that has on recovery and rehabilitation that that the lack of post-operative care and I mean at hospital bed space enough nurses to treat people. People are often discharged pretty soon, aren’t they, after surgery and they go back to tent camps to recover.

Dr. Khamis:
Yes, that’s a very important question. Actually, I used to work with my dear friend Dr. Ghasan at the beginning of the war at Shifa hospital and Ahli-Arab Hospital and together we have witnessed almost all wounds come to the operating theater with worms in these wounds and it is severely infected not only with ordinary bacteria but with massive maggots just moving around in the in the flesh of the patients. Why? because there is no water, no hygiene, no enough beds, no enough sanitation in the hospitals and the hospitals turn into more of a camp because thousands and thousands of them are just crowded in in the corridors everywhere. So we could barely even separate the patients with infections from those who have no infections. And I completely agree with Dr. Ghasan that even patients with salvable limbs will end up undergoing a mutation because of the severe infection in their wounds and even going deeper to the deeper tissue on the muscles and this could lead to the patient demise because this could lead to sepsis and early mortality among those patients. Going back to your question about the effect of nutrition in this all patients all Gazans are now suffering from malnutrition. Almost the whole population of Gaza have lost between 20 and 30% of their weight. And we are not speaking about just mild waste of nutrition. We are speaking about the nutritious materials, proteins, minerals, lack of nutritious materials like eggs, like milk, meat. People haven’t eaten meat in more than six months. Haven’t eaten eggs in more than a year now. So those patients with fractures need calcium need vitamin D to promote healing of the wounds. But there’s nothing here. The only thing available which is extremely expensive the way is carbohydrates in the form of flour or rice. That’s the only thing available. No meat, no proteins, no nutritious materials. Another thing even if they wanted to buy, no family could afford to buy anything. And not only that we have more than 95% of the Gazan population are living in in tents. So imagine with infected wounds and infected external fixator is living in a tent with no hygiene, no environmental sanitation, garbage is accumulating everywhere in the city in all streets. We have more than 250,000 tons of garbage not collected properly. We have a sewage system that is collapsing and sewage is everywhere in the street. So the whole health care system is collapsing and as I mentioned in the beginning of my talk that prior to the war the whole the health care system was barely functioning, now you have more than 31 hospitals out of 37 hospitals are out of service. Okay. So the patients find nowhere to be treated, nowhere to be rehabilitated except now we have Elwafa Hospital which is the only functioning rehabilitation center here. But unfortunately, we can’t cope with the large number of patients who need rehabilitation. We have a long waiting list of patients who come for rehabilitation. But no, you don’t have space to admit all of them with lack of prosthesis and lack of specialized personnel to really substitute the low limb with proper prosthesis and proper rehabilitation.

AF: Dr. Samah, coming back to what you were saying about the psychological impact of of the war, the incalculable psychological impact, of course, many of the victims we’re talking about here are children. The consequences of this will last well beyond the current generation, won’t it? I mean, these kids are going to grow up psychologically harmed as well as physically harmed. I mean, how do you go about treating that?

Dr. Samah:
Well, I don’t think that this drastic situation requires a conventional psychiatric intervention. It requires a political solution. This trauma is man-made and deliberate and it targets the resilience of the Palestinian people with every detail. The attack on people’s bodies but also the attack on their minds. when you’re talking about children, malnourished children will suffer from developmental delays. And we know that even adults from previous experiments that were done and performed on semi- starvation where people were sustained on 1,400 calories. We know that there was a severe physical and psychological impact and sometimes this impact will not be corrected as soon as people get nourished normally. It might take two to three years for people to recover from the psychological consequences. Starving people is an attack on their resilience, people lose their agency and their will and they start competing with each other in a very bad way over the leftovers of food. So this is a structured man-made attack on the Palestinian mental health for generations to come. And we also know that the people who are living these horrible conditions will suffer for many years to come, but also will pass this suffering and the psychological vulnerability for several generations to come.
AF.: Dr. Ghassan, what’s your message to the international community? What does it need to do right now? Okay, there’ve been some evacuation flights, but it’s a small number of people who’ve been taken out of Gaza to be treated apart from heroes such as yourself who risk their lives to go in and help on the ground. I mean the response to this this horror has been shameful, hasn’t it?

Dr. Ghassan:
I think the world is divided between two camps. Those states who have been complicit in the genocide of the Palestinians particularly in the starvation phase which is the final solution i.e finishing off the Palestinians and those states who have rung their hands and have decided that there’s nothing that they can do other than watch and make statements of condemnation. There seems to be an acceptance globally amongst the states at least, but not the peoples of Israel’s decision to wipe out the Palestinians. And wipe out the Palestinians, we mean literally wipe out the Palestinians. Um, this needs to stop. The genocide needs to be stopped because not just for the Palestinians because we know that if this war is successful in wiping out the Palestinians, the rest of the 21st century will become a genocidal century where wars are conducted in a way to wipe out problematic or surplus populations. There needs to be an immediate ceasefire. There needs to be immediate opening up of the borders so that food is allowed in, so that medical equipment is allowed in, so that medical teams and field hospitals are allowed in, and so that the wounded are allowed to be taken out for treatment. Anything short of that is an acceptance and either an active or a passive complicity in the genocide of the Palestinian people, the most televised genocide in the 21st century. Worse than Rwanda, worse than Srebrenica. We are witnessing something that humanity has never seen before. and states like the United States, UK, France, Italy, Germany are as complicit as the Israelis in the genocidal erasure of the Palestinian people.

AF: Okay. Dr. Khamis, what are your thoughts on that? What you’re in Gaza, what is your message to the international community? In a developed country, dealing with something like this would be a challenge. But in a place like Gaza, with Israel deliberately withholding access to medical care, systematically destroying the health care system, how on earth can it be allowed?

Dr. Khamis:
Thank you so much. In fact, Adrian, what I see here amongst our patients really breaks my heart because when we assist patient with spinal cord injury, foot injury, and we’re putting a plan for him really to start rehabilitation program with our team. Unfortunately, the patient because he hasn’t eaten in days, he could barely walk. Not only the patient, but even the family. and the family has no money even to pay for transportation or to buy food for the family. So it is a perplex problem. It’s a manmade catastrophe. I have written an article in the Lancet in the first few days of the war and I have put the title there preventing an imminent catastrophe because we know where the situation was going on from that moment and really what happened was a massive genocide of all Palestinian people. not only of the people who lost their lives, people who were injured, people who are left with permanent disability, but we are speaking about more than 50,000 orphans. We’re speaking about 20,000 kids without any family members left behind to collect them. We’re speaking about 12,000 missed bodies under the rubble of Gaza healthcare system. So it’s multitude multiplex of problems all together affecting Gaza from health care system food wise sanitation wise administrative wise and lack of everything. So my message to the world leaders you need to act and act seriously and act now before it’s too late, Maybe to save the remaining Palestinians here in Gaza. We’re not speaking only of the 150,000 plus injured persons with more than 25,000 with long-term disability. We’re speaking about also 350,000 individuals with chronic diseases ranging from heart disease, diabetes, hypertension, cancer who are dying in silence because either they can’t come to the hospital for follow-up or treatment or they don’t have the money or they afraid to come to the hospital and being killed in the streets. So many of them unfortunately died without even reaching their treatment. Out of 11,000 cancer patients, we have more than 2,000 who died in the past two years. Out of 3,000 patients with renal failure, almost 1,000 died while waiting to receive kidney dialysis. Imagine in the 21st century, we’re speaking about something that is symbol as a privilege here in Gaza to have one session of renal dialysis is considered as a privilege. So my message to the world leaders please we’re begging you open all borders to allow those patients who need to go out for better treatment to go out for treatment and stop the war so we don’t lose more than more and more thousands of and one last thing very quickly please 800 patient who lost their vision here in this world.

AF: Okay. Dr. Samah, the last word to you. We’ve got we’ve got a little over a minute left. Um your final thoughts on what your two colleagues were saying, but let’s look beyond the war for a moment. What international support is going to be needed in the long term to address Gaza’s healthcare crisis and to and to support its traumatized people?

Dr. Samah:
The sooner there will be a reaction, the better for the future of the Palestinian people. Psychological trauma consequences need to be treated as soon as possible and that should start by a political intervention that ends the manmade deliberate catastrophe that is taking place and then we can talk about rehabilitation and safety. Anything that can be done at the level of psychological rehabilitation will be inadequate as far as there is no safe place and as far as the international communities allowing this war to continue.

AF: and Dr. Samah are the is there the resilience there in the people have the resilience after the after this this devastating war to recover?

Dr. Samah:
Yes, we need to be careful when we talk about the resilience or the special word the Palestinians use sumud because pain and resilience are dialectical in the relationship. Not everyone who is exposed to trauma should develop traumatic consequences. Sometimes people have both traumatic consequences but they want to continue living and adversity can cause development and post-traumatic growth sometimes and we lived horrible conditions in 47-48. Our grandparents went through horrible conditions and the Palestinian population survived. So we hope that we will survive the tragedy that is taking place in Gaza.

AF: Now there we must end it. Many thanks indeed to you all doctors Khamis Ellesi, Samah Jabr and Ghasan Abu Sittah and thank you for watching. You can see the program again at any time by going to the website that’s at aljazeera.com. For further discussion you can join us at our Facebook page at facebook.com/ajjinsidstory and of course you can join the conversation on X. our handle there at AJ inside story from me, Adrien Finighan and the team here in Doha. We’ll see you again. Bye for now.